Microfluidic testing system for mobile veterinary applications

ABSTRACT

A method for generating a treatment plan in response to medical test results is provided. The method comprises requesting point-of-care (POC) services from a mobile POC unit, receiving at a server confirmation of delivery of POC services to a patient, receiving at the server one or more test results as a result of operation of a medical testing device used in the POC services, wherein the one or more test results includes a determination of the efficacy and dosage level of a medication, generating at the server an updated digital patient record reflecting the one or more test results, and transmitting by the server to a medical entity a treatment plan based on the efficacy and dosage level determined for the medication, wherein the treatment plan is a dosage regimen for the medication.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/191,262, filed Nov. 14, 2018, and entitled MICROFLUIDIC TESTINGSYSTEM FOR MOBILE VETERINARY APPLICATIONS, which is acontinuation-in-part of U.S. patent application Ser. No. 16/186,515,filed Nov. 10, 2018, and entitled COMMUNICATION LOOP AND RECORD LOOPSYSTEM FOR PARALLEL/SERIAL DUAL MICROFLUIDIC CHIP, which claims priorityto and the benefit of U.S. Provisional Patent Application No.62/584,661, filed Nov. 10, 2017, and entitled COMMUNICATION LOOP ANDRECORD LOOP SYSTEM FOR PARALLEL/SERIAL DUAL MICROFLUIDIC CHIP. Thisapplication also claims priority to U.S. Provisional Patent ApplicationNo. 62/639,500, filed Mar. 7, 2018, and entitled MICROFLUIDIC TESTINGSYSTEM FOR MOBILE VETERINARY APPLICATIONS. The contents of patentapplication Ser. Nos. 16/186,515, 62/584,661, and 62/639,500 areincorporated by reference herein in their entirety.

TECHNICAL FIELD

The following disclosure relates to a system connecting variousparticipants in a medical system to request point of care services.

BACKGROUND

The emergence and spread of antibiotic-resistant bacteria are aggravatedby incorrect prescription and use of antibiotics. This problem is due tothe fact that there is no sufficiently fast diagnostic test to guidecorrect antibiotic prescription at the point of care. Currently, somefluid sample is retrieved from a patient and forwarded to a lab fortesting to determine a specific treatment regimen. As a safeguard, thepatient is sometimes initially given large doses of a general antibioticuntil a more specific antibiotic can be determined to target thespecific bacteria. This can take upwards of two or three days, as theprocess requires growing the bacteria in some culture medium andobserving its response to various antibiotics.

SUMMARY

In one aspect thereof, a method for generating a treatment plan inresponse to medical test results is provided. The method comprisesrequesting point-of-care (POC) services from a mobile POC unit,receiving at a server confirmation of delivery of POC services to apatient, receiving at the server one or more test results as a result ofoperation of a medical testing device used in the POC services, whereinthe one or more test results includes a determination of the efficacyand dosage level of a medication, generating at the server an updateddigital patient record reflecting the one or more test results, andtransmitting by the server to a medical entity a treatment plan based onthe efficacy and dosage level determined for the medication, wherein thetreatment plan is a dosage regimen for the medication.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding, reference is now made to thefollowing description taken in conjunction with the accompanyingDrawings in which:

FIG. 1 illustrates a high-level view of a microfluidics chip of thepresent disclosure;

FIGS. 2A-2C illustrate detailed views of the multiple stages of analysisprovided by the microfluidics chip of FIG. 1 ;

FIGS. 3A-3D illustrate diagrammatic views of the various cell captureregions and the interspersed pumps for the microfluidics chip of FIG. 1;

FIGS. 4A-4G illustrates detailed views of the first viewing stage;

FIG. 5 illustrates a detailed view of the first parallel driving stage;

FIGS. 5A and 5B illustrate details of the coating applied to the microchannels in the first driving stage;

FIG. 6 illustrates a detail of the serial driving stage;

FIGS. 7A-7D illustrate detailed views of a valveless nozzle/diffusermicropump;

FIG. 8 illustrates a detailed view of a piezoelectric micropump;

FIG. 9 illustrates a detailed view of a multi-chamber micropump withcheck valves;

FIG. 10 illustrates a flowchart for the high-level operation of themicrofluidics chip;

FIG. 11 illustrates a flowchart for the initial loading operation of thefluid sample;

FIG. 12 illustrates a flowchart for the viewing or cell counter stage ofanalysis;

FIGS. 13A-13C illustrate diagrammatic use for the cell counter;

FIG. 14 illustrates a flowchart for the main parallel stage of analysis;

FIG. 15 illustrates the serial stage of analysis;

FIG. 16 illustrates a simple fight diagrammatic view of themicrofluidics chip;

FIG. 17 illustrates a simplified diagrammatic view of a parallel module;

FIG. 18 illustrates simplified diagrammatic view of a serial module;

FIG. 19 illustrates a simplified diagrammatic view of a serial modulearranged in parallel;

FIGS. 20A and 20B illustrated a diagrammatic view of an embodimentutilizing a chemostat;

FIG. 21 illustrates a diagrammatic you have the microfluidics chiputilizing valves;

FIGS. 22A and 22B illustrate cross-sectional views of a micro valve;

FIG. 23 illustrates a diagrammatic view of preparing a biologic sampleand disposing it in the well on the microfluidic chip;

FIG. 24 illustrates a cross-sectional view of an RT-lamp interfaced witha cell phone;

FIG. 25 illustrates a perspective view of the RT lamp interfaced with amicrofluidic chip and a cell phone;

FIG. 26 illustrates a side view of a cell phone interfacing with themicro fluidic chip;

FIG. 27 illustrates a window view of the camera and the alignmentprocess;

FIGS. 28A-28H illustrate multiple views of a diagram of the microfluidicchip in schematic form and various loading and analysis steps associatedthere with;

FIG. 29 illustrates a flowchart for the overall analysis processutilizing the microfluidic chip;

FIG. 30 illustrates a flowchart to pick in the details of the test path;

FIG. 31 illustrates a diagrammatic view of a biofluidic triggeringsystem in accordance with various embodiments of the present disclosure;

FIG. 32 illustrates a diagrammatic view of an analog testing device to adigital format and unique identifier conversion process;

FIG. 33 illustrates one example of a unique identifier in accordancewith various embodiments of the present disclosure;

FIG. 34A illustrates an embodiment in which one of the data streams ofthe unique identifier is a test identification, TID field;

FIG. 34B illustrates an embodiment in which one of the data streams ofthe unique identifier is a unique device identification, or UDID field;

FIG. 34C illustrates an embodiment which includes a SOID (self/otheridentification) field;

FIG. 34D illustrates an embodiment which includes a data stream whichcontains demographic information;

FIG. 34E illustrates an embodiment in which the unique identifiercontains a data stream which indicates whether or not the user hassupplied their personal email address;

FIG. 34F illustrates an embodiment of a data stream for a uniqueidentifier which contains a timestamp of when a completed medical testis scanned or photographed by the mobile application;

FIG. 34G illustrates a data stream for an embodiment in which a uniqueidentifier contains information related to the results of a medicaltest;

FIG. 34H illustrates a data stream for an embodiment in which a uniqueidentifier includes an indication of whether or not the user wishes tohave the test results sent to a healthcare provider;

FIG. 34I illustrates a data stream for an embodiment in which a uniqueidentifier includes information identifying the user's healthcareprovider;

FIG. 34J illustrates a data stream for an embodiment in which a uniqueidentifier includes information relating to a retail suggestion;

FIG. 34K illustrates a data stream for an embodiment in which a uniqueidentifier includes information identifying the user's insurance I.D.;

FIGS. 35A and 35B illustrate systems for transmitting prescriptions to apharmacy using telemedicine;

FIG. 36 illustrates an embodiment of a system which utilizes a remotediagnostic test to initiate a medical escalation and intervention;

FIG. 37 illustrates an example of a table which would be found in thedatabase of a central office and which contains criteria for when toinitiate a medical intervention based on the results of a remotediagnostic test;

FIG. 38 illustrates an embodiment which includes mapping a diagnostictest to an individual user to create a unique profile on a remotedatabase;

FIG. 39 illustrates an example of a unique biologic ID database table;

FIG. 40 illustrates an embodiment which includes mapping diagnostictests to individual users to create unique profiles;

FIG. 41 illustrates a flowchart for an embodiment which includes mappinga diagnostic test to an individual user to create a unique profile on aremote database;

FIG. 42 illustrates a diagrammatic view of a medical test results,trends, and response system;

FIG. 43 illustrates information that may be recorded in a patientrecord;

FIG. 44 illustrates a flowchart of a patient record update/creationprocess;

FIG. 45 illustrates a sequence diagram of a test results and treatmentregimen enactment process;

FIG. 46 illustrates a diagrammatic view of a trends engine in accordancewith various embodiments of the present disclosure;

FIG. 47 illustrates one embodiment of database tables showing aparticular trend;

FIG. 48 illustrates a sequence diagram of a research and trends feedbackprocess;

FIG. 49 illustrates a medical condition trend activation process;

FIG. 50 illustrates a diagrammatic view of one embodiment of a systemdevice that may be used within the environment described herein;

FIG. 51 illustrates a block diagram of a mobile point-of-care system inaccordance with embodiments of the present disclosure;

FIG. 52 illustrates an example mobile application POC request interfacein accordance with embodiments of the present disclosure;

FIG. 53 illustrates a flowchart of one embodiment of a POC servicerequest process;

FIG. 54 illustrates a flowchart of one embodiment of the POC serviceprocess;

FIG. 55 illustrates a flowchart of one embodiment of a POC servicesprovisioning process; and

FIG. 56 illustrates a sequence diagram of one embodiment of a mobile POCunit request and POC service process.

DETAILED DESCRIPTION

Referring now to the drawings, wherein like reference numbers are usedherein to designate like elements throughout, the various views andembodiments of a microfluidic testing system with cell capture/analysisregions for processing a parallel and serial manner is illustrated anddescribed, and other possible embodiments are described. The figures arenot necessarily drawn to scale, and in some instances the drawings havebeen exaggerated and/or simplified in places for illustrative purposesonly. One of ordinary skill in the art will appreciate the many possibleapplications and variations based on the following examples of possibleembodiments.

Referring now to FIG. 1 , there is illustrated a diagrammatic view of amicrofluidics chip 102 at a high-level view. There is provided in themicrofluidics chip 102 an input stage 104 that is operable to receive abiological specimen. As used herein, a “sample” must be capable offlowing through microfluidic channels of the system embodimentsdescribed hereinbelow. Thus, any sample consisting of a fluidsuspension, or any sample that be put into the form of a fluidsuspension, that can be driven through microfluidic channels can be usedin the systems and methods described herein. For example, a sample canbe obtained from an animal, water source, food, soil, air, etc. If asolid sample is obtained, such as a tissue sample or soil sample, thesolid sample can be liquefied or solubilized prior to subsequentintroduction into the system. If a gas sample is obtained, it may beliquefied or solubilized as well. The sample may also include a liquidas the particle. For example, the sample may consist of bubbles of oilor other kinds of liquids as the particles suspended in an aqueoussolution.

Any number of samples can be introduced into the system for analysis andtesting, and should not be limited to those samples described herein. Asample can generally include any suspensions, liquids, and/or fluidshaving at least one type of particle, cellular, droplet, or otherwise,disposed therein. In some embodiments, a sample can be derived from ananimal such as a mammal. In a preferred embodiment, the mammal can be ahuman. Exemplary fluid samples derived from an animal can include, butare not limited to, whole blood, sweat, tears, ear flow, sputum, bonemarrow suspension, lymph, urine, brain fluid, cerebrospinal fluid,saliva, mucous, vaginal fluid, ascites, milk, secretions of therespiratory, intestinal and genitourinary tracts, and amniotic fluid. Inother embodiments, exemplary samples can include fluids that areintroduced into a human body and then removed again for analysis,including all forms of lavage such as antiseptic, bronchoalveolar,gastric, peritoneal, cervical, athroscopic, ductal, nasal, and earlavages. Exemplary particles can include any particles contained withinthe fluids noted herein and can be both rigid and deformable. Inparticular, particles can include, but are not limited to, cells, aliveor fixed, such as adult red blood cells, fetal red blood cells,trophoblasts, fetal fibroblasts, white blood cells, epithelial cells,tumor cells, cancer cells, hematopoeitic stem cells, bacterial cells,mammalian cells, protists, plant cells, neutrophils, T lymphocytes,CD4+, B lymphocytes, monocytes, eosinophils, natural killers, basophils,dendritic cells, circulating endothelial, antigen specific T-cells, andfungal cells; beads; viruses; organelles; droplets; liposomes;nanoparticles; and/or molecular complexes. In some embodiments, one ormore particles such as cells, may stick, group, or clump together withina sample.

In some embodiments, a fluid sample obtained from an animal is directlyapplied to the system described herein at the input stage, while inother embodiments, the sample is pretreated or processed prior to beingdelivered to a system. For example, a fluid drawn from an animal can betreated with one or more reagents prior to delivery to the system or itcan be collected into a container that is preloaded with such a reagent.Exemplary reagents can include, but are not limited to, a stabilizingreagent, a preservative, a fixant, a lysing reagent, a diluent, ananti-apoptotic reagent, an anti-coagulation reagent, an anti-thromboticreagent, magnetic or electric property regulating reagents, a sizealtering reagent, a buffering reagent, an osmolality regulating reagent,a pH regulating reagent, and/or a cross-linking agent.

At this point in the process, a finite amount of biofluids is disposedin the reservoir ready for transferring to subsequent stages. Thisamount of fluid is then transferred to another stage via a driving stage106 in order to transfer this biofluid to another reservoir, thatassociated with a viewing stage 108. At this stage, a technician canexamine the biofluid and determine the makeup of the biofluid,discriminate cells, etc. in order to make certain decisions as to goingforward with remaining tests. The microfluidic chip then transfers thebiofluid at the viewing stage 108 to a parallel analysis stage 115through a parallel driving stage 110 wherein the biofluid is dividedamong a plurality of parallel path this for analysis of the reaction ofthe material in the biofluid with different reagents in a reading. Thisrequires a certain amount of the biofluid to be transferred to thisanalysis stage. Thereafter, a decision is made as to whether to transferthe remaining biofluid from the viewing stage 108, in order to performmore testing and/or analysis on the biofluid. At this stage the process,only one of the multiple second stage or serial stage path is selected.One reason for this is that there is only a finite amount of biofluidavailable and there is no need for testing along paths that areassociated with previous decisions indicating that the results will benegative along these paths. Each of these serial passes associated withone of the parallel paths. Thus, if there are five parallel paths, therewill be five serial paths. Note that the term “serial path” is a termmeaning that it is within the serial decision tree and it need notactually be a plurality of serial paths that are linked together in aserial manner, although they could be and are in some embodimentsdescribed hereinbelow. It is necessary to perform the testing/analysisalong each of the five parallel paths, but a decision at this pointindicates that only one of the serial paths will be required for thetesting/analysis purpose. This will be described in more detailhereinbelow.

Referring now to FIGS. 2A-2C, there are illustrated diagrammatic viewsof the various stages of the process. With specific reference to FIG.2A, there is illustrated a diagrammatic view of first viewing stage,wherein the amount of biofluid stored in the input stage reservoir 104is driven to the viewing stage 108 reservoir. At this stage, opticaldevice 202, for example, can be used to view the cells disposed withinthe medium. This medium could actually be the actual biofluid that wasprovided in the sample from the human/animal or could be some dilutedversion thereof. However, this biofluid will contain some cellularmaterial or some particulate of interest. This can be viewed with theout device 202 and then passed to a processor 204, or a human couldanalyze the results. With utilization of the processor 204, the actualform of biofluid, and analog form, is transferred to a digital form.This could be in the form of cell counting for verification of aparticular cell. As will be described hereinbelow, affinity labels canbe associated with each of the cells or particulates in the biofluid andthis could facilitate visual recognition of different characteristics ordifferent types of cells, such as proteins, bacteria, etc. Each of thesecellular materials can have a particular affinity label associated therewith that allows it to be visually identified via some characteristicssuch as florescence or even magnetic properties associated with theaffinity label. Again, this will be described hereinbelow. Although anoptical device 202 was illustrated and described, any other type ofdevice for analyzing the characteristics of a particular affinitylabeled cell can be utilized, such as some type of magnetometer, etc.

Referring now to FIG. 2B, there is illustrated the next parallel drivestage. At this stage, a micropump is utilized in the parallel drivestage 110 to pump at least a portion of the biofluid stored in thereservoir associated with the viewing stage 108 is transferred to all ofthe parallel reading/analysis paths. In this step, it can be seen that aportion of the biofluid in the reservoir associated with the viewingstage 108 and is biofluid exists in each of these parallel paths foranalysis. There is an indication in one of these parallel paths,associated with the reservoir 210, that shows a positive indication of areaction of some type that is viewable. If, for example, this werebacteria, one reagent could be an antibiotic in a large dosage thatwould destroy the particular target bacteria and this would berecognized by an observer. The other three paths, associated withreservoirs 214, 216 and 218 (an example of 4 paths), would have noreaction and, as such, would not have affected the bacteria associatedtherewith. In this example, a high level of concentrated antibiotic isprovided that would destroy the bacteria, but at this level of analysis,there is no indication provided as to the actual dosage of thatantibiotic that would destroy the bacteria, other than the fact that alarge dosage of this particular antibiotic will destroy the targetbacteria. It is important to keep in mind that this particular biofluidmay have multiple and different bacteria, proteins, etc. containedtherein.

Referring now to FIG. 2C, there is illustrated a diagrammatic view ofthe final serial stage of analysis/testing. Since the first stage oftesting/analysis transferred some of the biofluid from the viewing stage108 to the parallel stages 114, there is still some biofluid remainingin the viewing stage 108. This is a selectively transferred to one ofthe serial paths, that associated with the testing reservoir 210. Thereare provided a plurality of bypass channels 220 associated with each ofthe serial paths and only the bypass channel 220 associated with thereservoir 210 in the parallel path 114 will be selected for transferringbiofluid to this particular serial path associated with the reservoir210 for testing. It will first be pumped to be a micropump in a serialdrive stage 222 to a first serial reservoir 224 for testing/analysis. Ifthe test is negative, it can then be passed to a subsequent serialdriving stage 226 to a subsequent serial reservoir 228 fortesting/analysis and so on. As will be described hereinbelow, there canbe provided a single bypass path 220 which is connected to a manifoldassociated with each of the serial paths and each of the manifolds canbe associated with each of the different reservoirs for testing, i.e.,at this point the testing is parallel to all of the subsequent testingreservoirs. In the mode illustrated in this FIG. 2C, it is necessary totransfer all of the necessary biofluid, i.e., typically the remainingbiofluid in the viewing stage reservoir 108, to the reservoir 224 andpass all of that biofluid to the next reservoir 228 and so on. Thus, ateach stage, all of the biofluid transferred in the subsequent stages istested at each subsequent stage. In a parallel configuration, theremaining biofluid in the viewing stage 108 would be required to bedivided among the different testing reservoirs at each of the subsequentstages. This will be described in more detail hereinbelow.

Referring now to FIGS. 3A-3D, there are illustrated diagrammatic viewsof the process and fluid flow. In FIG. 3A come there is illustrated anoverall process flow for the embodiment described hereinabove. Thisembodiment, there is provided an input well 302 for receiving thebiologic sample indicated by numeral 303. This constitutes a finitevolume that must be transferred via a micropump to a viewing reservoir306. At this point, substantially all of the biofluid is transferredfrom the reservoir 302 to the viewing reservoir 306. This is the firststage of the process. The second stage of the process is illustrated asproviding three separate testing reservoirs 308, 310, 312, attached atone to a microchannel manifold 314. Each of the testing reservoirs 308,310, 312, as will be described hereinbelow, is comprised of a serpentinemicrochannel 316 attached at one end to the manifold 314 and at theother end to a viewing reservoir 318. A micropump 320 is provided fortransferring biofluid from the viewing reservoir 306 to the manifold314. This will be divided among the three testing reservoirs 308, 310,312 and substantially even amounts. The biofluid will traverse theserpentine microchannel 316, which is coated with a particular reagent,one example being an antibiotic. In this example, the antibiotic is at avery high concentrated level, each of the testing reservoirs 308, 310and 312 having a different antibiotic associated there with. Only aportion of the biofluid in the viewing reservoir 306 will be transferredto these three testing reservoirs 308, 310 and 312 for testing/analysisand viewing at the associated viewing reservoir 318. The serpentineshape, when used with a medium containing cells such as in a biologicsample, facilitates and enhances mixing due to the increased interfacialcontact area between the cells within the biofluid sample.

The next step of testing/analysis will be selected only upon a positivetest occurring within one of the three testing reservoirs 308, 310 and312. However, each of the testing reservoirs 308, 310 and 312 hasassociated there with a subsequent group of testing reservoirs. In thisembodiment, each of the subsequent testing reservoirs is comprised of aplurality of sub reservoirs 330, each of the sub reservoirs 330 beingconfigured identical to the testing reservoirs 308, 310 and 312, with aserpentine microchannel region 316 and a viewing reservoir 318. A singlebypass microchannel 220 is provided to connect viewing reservoir 306 toa sub reservoir manifold 332. Each of the particular sub reservoir pathshave associated there with a separate micropump 334. Only one of thesemicropumps 334 is selected for transferring the remaining portion of thebiofluid stored in the viewing reservoir 306 to the selected path. Inthis embodiment, the remaining portion of the biofluid is transferred tothe first reservoir 330 bypassing the biofluid through the serpentinemicrochannel 316 to the associated viewing reservoir 318. Thisparticular microchannel will have coating of antibiotic, in this exampleabove, at a relatively low dose. If the bacteria, for example, do notreact accordingly with this level of antibiotic, it can be recognized assuch in the viewing reservoir 318. It is noted that the antibioticassociated with the coating on the walls of the microchannel 330 at thisdosage will not be picked up by the bacteria and, as such, the bacteriain the viewing reservoir 318 for the first sub reservoir 330 in theselected path will still be intact. It can then be pumped from thereservoir 318 associated with the first testing reservoir 330 in thechain to a subsequent testing reservoir 330 with a subsequent micropump336. This subsequent sub reservoir will have a concentration ofantibiotic in its serpentine microchannel 316 that is at a higher level.As the level increases, a gradient is tested for, such that the dosagecan be gradually increased until the bacteria are destroyed. If, forexample, the bacteria were associated with an affinity label that madeit fluoresce, this would be recognized. It could also be that there aremultiple bacterial types contained within the biofluid that are eachassociated with a different affinity label and this could be recognized.It could, in fact, the case that one type of bacteria perfected at afirst dosage level of the antibiotic and a second bacteria were affectedat a another dosage level of the antibiotic.

Referring now to FIG. 3B, there is illustrated a diagrammatic view of analternate process flow. This will work substantially identical to theembodiment of FIG. 3A, come up until the operation at the manifold 332associated with the sub reservoirs. In this embodiment, the threemicropumps 334 each feed a sub reservoir manifold 340. Each of the subreservoir manifolds 340 is connected to a plurality of the subreservoirs 330 associated with each path. In this embodiment, there areonly illustrated three sub reservoirs 330 for each of the sub reservoirmanifolds 340, although each path could have a different number of subreservoirs 330 associated therewith. The difference between these twoembodiments is that, at this point, the amount of biofluid remaining inthe viewing reservoir 306 now must be divided amongst all of the subreservoirs attached on one end thereof to the associated sub reservoirmanifold 340 selected by the activated one of the micropumps 334. Thiswill result in potentially less biofluid being available for thetesting/analysis step. This will also mean that each of the viewingreservoirs 318 associated there with will have a smaller volumeassociated therewith.

Referring now to FIG. 3C, there is illustrated a diagrammatic view thatprovides a simplified diagram of the transfer from reservoir toreservoir. In this illustration, the input stage is illustrated as aninput reservoir 350 labeled R0. A micropump 352 is operable to transferthe contents of this input reservoir, the biofluid, to a secondreservoir, a viewing reservoir 354, labeled R1. A portion of thecontents of this reservoir are then transferred via a micropump 356 to aplurality of parallel stage reservoirs 358 labeled R2. This is the firsttesting/analysis stage. After this stage, the remaining contents of theviewing reservoir 354 are transferred to the subsequent serial stagereservoirs via a pump 360 via a bypass path and microchannel 362. Theserial stage reservoirs are labeled R3, R4, etc. This illustration setsforth how the entire contents of the input reservoir R0 are transferreddown the chain. This is best illustrated in FIG. 3D. In thisillustration, it can be seen that entire contents of reservoir R0 aretransferred to reservoir R1. At this point, only a portion of thecontents are transferred to reservoir R2. The remaining contents aresequentially transferred to R3, R4, and so on. For this illustration,the entire remaining contents of the reservoir 354, R1, will betransferred down the chain entirely to reservoir R3, then to reservoirR4, and so on. In the alternate embodiment, as described hereinabove,and not illustrated in FIG. 3D, the bypass 362 could be connected toeach of the reservoirs R3, R4, etc. in parallel, noting that theremaining contents of the reservoir R1 will then be divided amongst theparallel connected reservoirs R3, R4, etc.

Referring now to FIGS. 4A-4G, there are illustrated diagrammatic viewsof the initial processing section associated with the viewing stage 108.There is provided a substrate 402 upon the surface of which are formed aplurality of wells and microchannels. A first well 404 is provided forreceiving the biofluid sample in this well has a finite volumeassociated there with. At the bottom of this well a microchannel 406extends outward and up to the surface to an opening 408. The purpose ofthis microchannel 406 extending to the bottom of the well 404 is toensure that the biofluid can be completely pumped from the well 404. Forthe formation of this microchannel 406, it might be that themicrochannel is formed through the surface of the substrate 402 and thena cover plate (not shown) having a surface that extends down into theopen microchannel. An adjacent channel 410 is disposed proximate theopening 408 to provide another opening therefore in order to accommodatea micropump 412 (shown in phantom) interface with the opening 408 andthe one end of the microchannel 410 for transferring fluid from the well404 to the microchannel 410. The microchannel 410 extends along thesurface of substrate 402 in order to interface with a viewingwell/reservoir 412. As the biofluid passes through the microchannel 410and the viewing well 412, a desired analysis can be performed on thecontents of the biofluid. As described hereinabove, in one example,various cells in the biofluid might consist of different types ofbacteria, proteins, etc. and each of these may have associated therewith a specific affinity label, which is optically detectable. Thereare, of course, other means by which affinity labels can be detected. Asthe cells contained within the biofluid pass through the viewingwell/reservoir 414, they can be examined. The viewing well/reservoir 414on the other side thereof is connected to one side of a microchannel416, the other side thereof connected to a reservoir 418. Since themicropump 412 must force the biofluid through the microchannels and theviewing well/reservoir 414, there is required the necessity for aholding reservoir 418 to be present. However, initially, this reservoir418, the microchannel 410 and the viewing well/reservoir 414 will haveair disposed therein. This air must be removed. This can be done with anegative pressure of some sort or just a waste gate output to theatmosphere. This is provided by a waste gate microchannel 420 that isconnected to an opening 422 through the cover glass (not shown) or tothe side of substrate 402. A valve 423 could be provided above theopening 422. As biofluid enters the reservoir 418, air will be pushedout through the microchannel 420. It is desirable for this microchannel422 to have as low a profile as necessary such that only air exitstherefrom. Depending upon the size of the cells contained within thebiofluid, the microchannel 420 can be significantly smaller and have alower profile than the microchannels 410 and 416. Is important to notethat, once the micropump 412 transfers the biofluid from the well 404,the volume transferred will be spread between the two microchannels 410and 416, the viewing well 414 and the reservoir 418. Thus, the reservoir418 has a significantly larger volume that any of the microchannels 410and 416 and the viewing well/reservoir 414. Additionally, it may be thatthe depth of the wells/reservoirs 404 and 418, as well as the viewingwell reservoir 414 are also as shallow as the microchannels 410 and 416but significantly wider to accommodate the required volume.

The outlet of the reservoir 418 is connected from the bottom thereofthrough a microchannel 426 to an opening 428 on the upper surface of thesubstrate 402. This is interfaced with a micropump 430 (in phantom) toan adjacent microchannel 432 for subsequent processing. These micropumps412 and 430, although illustrated as being flush with the substrate,will typically be disposed above the cover plate (not shown) with holesdisposed through the cover plate. The opening 428 will be a horizontalmicrochannel associated with the manifold 314 described hereinabove.This will be associated with a plurality of micropumps 430 for each ofthe parallel paths or the bypass path. A cross-sectional view of theembodiment of FIG. 4A is illustrated in FIG. 4B, with a cover plate 440disposed over the substrate 402 with an opening 442 disposed above thewell 404 for receiving the biofluid sample.

FIGS. 4C and 4D illustrate top view and cross-sectional views of thereservoir 418 illustrating how the microchannel 416 feeds biofluid intothe top of the reservoir 418, and the flow path for the biofluid fromthe reservoir 418 through the microchannel 426 from the bottom of thereservoir 418. However, it may be that, with capillary action, the depthof the reservoir 418 could be equal to that of the microchannels 416 and426 such that they are all at the surface of the substrate 402 for easeof manufacturing. When a negative pressure is placed upon the reservoir418, air will be pulled into the microchannel 426 through themicrochannel 420. It is possible in this mode that the micropump 412could be operated to actually create a positive pressure in themicrochannel 416 to force the biofluid in the reservoir 418 into theopening 428 through the microchannel 426. Again, the microchannel 420would preferably have a dimension that was smaller than the smallestcell size within the biofluid.

Referring now to FIGS. 4E and 4F, there are illustrated top view andcross-sectional views of the reservoir 418 with an alternate embodimentillustrating microchannel 426′ as being beneath the bottom of thereservoir 418 to allow more complete emptying of the reservoir 418.

Referring now to FIG. 4G, there is illustrated an alternate embodimentof inlet wells for receiving the biofluid sample. There is provided thewell 404 for receiving the biofluid sample and a second well 464receiving an additional fluid sample. This fluid sample in well 460could be some type of dilutant or it could be a medium containingvarious affinity labels. As noted hereinabove, the fluid sample couldhave associated there with affinity labels prior to the biofluid samplebeing disposed in the well 404. However, it is possible that themicrofluidic chip have disposed in the well 460 a medium containingaffinity labels, for example. The well 460 would be interfaced through amicrochannel 462 to an opening 464 adjacent the opening 408. A twoinput, one output, micropump 412′ that interfaces with the microchannel410.

Referring now to FIG. 5 , there is illustrated a diagrammatic view ofthe microchannel structure associated with the parallel stage ofoperation. The microchannel 426 is interfaced with a microchannelmanifold 502 which corresponds to the opening 428. This microchannelmanifold 502 is interfaced with a plurality of micropumps 504,corresponding to the micropump 430. These micropumps 504 are disposed inpairs, each pair associated with one testing reagent. As notedhereinabove, there are provided a plurality of parallel paths, eachassociated with a reservoir 312 having a serpentine microchannel 316 anda viewing reservoir 318. The first micropump 504 in the pair ofmicropumps 504 is connected to one end of the associated serpentinemicrochannel 316. When this micropump 504 is activated, biofluid fromthe reservoir 418 is passed through the manifold microchannel 502 andthrough the serpentine microchannel 316 to the viewing reservoir 318. Aswas the case above, there is provided a waste microchannel 506 for eachof the reservoirs 318 to allow air to escape therefrom as biofluid isforced through the microchannel 316. The micropump 504 associated withthis serpentine microchannel 316 will be operated for a sufficientamount of time to transfer sufficient biofluid from the reservoir 418through the serpentine a channel 316 and finally into the reservoir 318to fill the reservoir 318. The microchannel 506 can have some type ofvalve associated with the opening thereof to prevent the escape of anybiofluid therefrom or, alternatively, the dimensions of thatmicrochannel 506 could be small enough to prevent any appreciable amountof cells escaping therefrom. Although not illustrated, the one of thepair of micropumps 504 associated with the parallel stage of operationand associated reservoirs 312 will also be operated to fill theassociated serpentine microchannel 316 and reservoir 318.

Referring now to FIGS. 5A and 5B, there are illustrated cross-sectionalviews of the serpentine microchannel 316. As described hereinabove, thesides of these channels 316 are coated with some type of reagent. Forexample, if a Urinary Tract Infection (UTI) were suspected and werebeing tested for in the microfluidic chip, the sensitivity for commonantimicrobial agents for UTI treatment might include ampicillin (AMP),ciprofloxacin (CIP), and trimethoprim/sulfamethoxazole (SXT), thesebeing three agents that could be tested for and three different paths.The bacteria that might exist within the urine samples from anindividual could be any of uropathogenic E. coli strains (EC132, EC136,EC137, and EC462). Some prior research has shown that, throughantimicrobial resistance profiles of these pathogens that EC132 isresistant to AMP and CIP but not SXT. EC136 is resistant to AMP only.EC137 is sensitive to all the antibiotics tested. EC462 is resistant toAMP and SXT but not CIP. In order to coat sides of the serpentinemicrochannels 316, one technique would to have a certain amount of theantibiotic dissolved in sterile water to the serpentine microchannels316 at different levels. Subsequently, the diluted antibiotic is driedby incubation at a desired temperature and desired time. The originaldiluted antibiotic has a starting concentration of a predetermined μg/mlconcentration. The surface area is sufficiently covered such that, whenthe biofluid passes thereover, it will interact with reagent.

Referring now to FIG. 6 , there is illustrated a microchannel diagram ofthe reservoir 330 on the surface of the chip 402. This is connected bythe microchannel 507 from the associated one of the micropumps 504.After the results in the viewing reservoir 318 have been determined toyield a positive result, for that particular path in the parallelanalysis/testing operation, the other of the pair of micropumps 504 isactivated and the remaining amount of micro-fluid from the reservoir 418is transferred to the reservoir 330. This will be passed through theserpentine microchannel 316 and stored in the reservoir 318, labeled 602in FIG. 6 . This is substantially larger than the reservoir 318associated with the reservoir 312. Thus, for this embodiment, theremaining portion of the biofluid from the reservoir 418 will besubstantially stored in the reservoir 602. This will have associatedthere with a waste microchannel 604 and an outlet microchannel 608 thatextends outward from the bottom of the reservoir 602 and up to anopening 610 in the surface of the substrate for interface with themicropump 336. The micropump 336 is operable, at the next stage of thetesting/analysis, to move the contents of the reservoir 602 over to thenext reservoir 330 for testing at that next concentration levelassociated with the next reservoir 330 in the sequence.

Referring now to FIGS. 7A-7D, there is illustrated an example of avalveless MEMS micropump. The micropump includes a body 702 with twopumping chambers 704 and 706. At the inlet side of each of the chamber704 and 706 is disposed a conical inlet 710 and 712, respectively. Theconical inlets 710 and 712 are wider at the pump chamber side andnarrower at the inlet side thereof. The inlet sides of conical inlet 710and 712 are connected to respective inlet channel 714 and 716. Theoutlet side of the chambers 704 and 706 are interfaced with conicaloutlets 718 and 720, respectively, the conical outlets 718 and 720having a narrower portion at the outlet of the respective pump chamber704 and 706 and a wider portion at the respective outlet thereofinterfacing with respective outlet channels 722 and 724. The conicalinlets 710 and 712 and outlets 718 and 720 are frustro conical in shape.A piezoelectric membrane and actuator 726 is dispose between the twopumping chambers 704 and 706 and is operable to be extended up into oneof the chambers 704 and 706 at one time to increase the pressure thereinand at the same time extend away from the other of the chambers 704 and706 to decrease the pressure therein. The operation is then reversed.

The piezoelectric membrane and actuator 726 is comprised of apiezoelectric disc 740 on one side of a membrane 742 and a piezoelectricdisc 744 on the other side thereof. Each of the piezoelectric discs 740and 744 are formed by stratifying a layer of use electric material 748between two layers of conducting material 750. Piezoelectric material748 can be made with Piezo Material Lead Zirconate Titanate (PZT-SA),although other piezoelectric materials can be used. The conductingmaterial 60 may be composed of an epoxy such as commercially availableEPO-TEK H31 epoxy. The epoxy serves as a glue and a conductor totransmit power to the piezoelectric discs 750. The piezoelectric discs750 are secured to the surface of the intermediate layer 748, so thatwhen a voltage is applied to the membrane 742, a moment is formed tocause the membrane 742 to deform.

The operation of the micropump will be described with reference to FIG.7D. At rest, the upper chamber 704 and the lower chamber 706 areseparated by a diaphragm pump membrane 742. The diffuser elements 710,712, 718 and 720 are in fluid communication with each respectivechamber. Diffuser elements are oriented so that the largercross-sectional area end of one diffuser element is opposite the smallercross-sectional area end of the diffuser element on the other side ofthe chamber. This permits a net pumping action across the chamber whenthe membrane is deformed.

The piezoelectric discs are attached to both the bottom and the top ofthe membrane. Piezoelectric deformation of the plates is varied byvarying the applied voltage so as to excite the membrane with differentfrequency modes. Piezoelectric deformation of the cooperating platesputs the membrane into motion. Adjustments are made to the appliedvoltage and, if necessary, the choice of piezoelectric material, so asto optimize the rate of membrane actuation as well as the flow rate.Application of an electrical voltage induces a mechanical stress withinthe piezoelectric material in the pump membrane 742 in a known manner.The deformation of the pump membrane 742 changes the internal volume ofupper chamber 704 and lower chamber 706. As the volume of the upperchamber 704 decreases, pressure increases in the upper chamber 706relative to the rest state. During this contraction mode, theoverpressure in the chamber causes fluid to flow out the upper chamber704 through diffuser elements on both sides of the chamber. However,owing to the geometry of the tapered diffuser elements, specifically thesmaller cross-sectional area in the chamber end of the left diffuserelement relative to the larger cross-sectional area of the rightdiffuser element, fluid flow out of the left diffuser element is greaterthan the fluid flow out the right diffuser element. This disparityresults in a net pumping of fluid flowing out of the chamber to theleft.

At the same time, the volume of the lower chamber 706 increases with thedeformation of the pump member 742, resulting in an under pressure inthe lower chamber 706 relative to the rest state. During this expansionmode, fluid enters the lower chamber 706 from both the left and theright diffuser elements. Again owing to the relative cross-sectionalgeometry of the tapered diffuser elements, fluid flow into the lowerchamber 706 through the right diffuser element is greater than the fluiddrawn into the lower chamber 706 through the left diffuser element. Thisresults in a net fluid flow through the right diffuser element into thechamber, priming the chamber for the pump cycle.

Deflection of the membrane 742 in the opposite direction produces theopposite response for each chamber. The volume of the upper chamber 704is increased. Now in expansion mode, fluid flows into the chamber fromboth the left and right sides, but the fluid flow from the rightdiffuser element is greater than the fluid flow from the left diffuserelement. This results in a net intake of fluid from the right diffuserelement, priming the upper chamber 704 for the pump cycle. Conversely,the lower chamber 706 is now in contraction mode, expelling a greaterfluid flow from the lower chamber 706 through the left diffuser elementthan the right diffuser element. The result is a net fluid flow out ofthe lower chamber 706 to the left.

Referring now to FIG. 8 , there is illustrated a cross-sectional view ofa piezoelectric micropump with check valves. Membrane 802 is disposedwithin a pump chamber 804 and secured to a body 806. A piezoelectricdisc 808 is disposed beneath the membrane 802 and electrode 810 isdisposed below the piezoelectric disc 808. Deformation of the membrane802 with the piezoelectric disc at the appropriate frequency will causea volume of the pumping chamber 804 to change. An inlet valve 811 allowsfluid to flow into the chamber 804 and an outlet valve 812 allows fluidto flow out of the chamber 804.

Referring now to FIG. 9 , there is illustrated a micropump 960 in whicha nanofabricated or microfabricated fluid flow pathway is formed betweenstructures. A first reservoir 961 terminates with a first gate valve 966which permits or restricts fluid flow between the first reservoir 961and a second reservoir 971. An electrolytic pump 985 drives a firstdiaphragm 965 which is communication with the second reservoir 971, toclose the first gate valve 966, and pulls a second diaphragm 969, whichopens a second gate valve 968 to drive fluid from the second reservoir971 to a third reservoir 973. The electrolytic pump 985 is driven byelectrowetting of a first membrane 964 on the first gate valve 966 sideof the pump. By switching to electrowetting of a second membrane 963fluid within the third reservoir 973 is emitted from an exit opening 970by actuation of the second diaphragm 969.

Referring now to FIG. 10 , there is illustrated a flowchart depictingthe overall operation of the system. The process is initiated at a Startblock 1002 and then proceeds to a block 1004, wherein the biofluidsample is loaded. The process enclosed a block 1006, wherein thebiofluid is transferred to the viewing window or the cell counter. Theprocess then flows to a decision block 1008 to determine when thecounting operation is done, i.e., when the cells have beendiscriminated. As noted hereinabove, each of these cells could beassociated with, depending on upon the type, a particular affinity labelto allow them to be discriminated between within the viewing window. Theprocess then flows to a block 1010 in order to pump the biofluidmaterial to the next phase, that associated with the paralleltesting/analysis step. A decision is then made at a block 1012 as towhether this is a positive state, i.e., has any of the biofluid materialinteracted with a particular reagent to give a positive result. If not,the process is terminated at a block 1014 and, if so, the process flowsto a block 1016 in order to capture the biofluid material in a secondaryreservoir. Once the path is selected, the appropriate micropump isactivated and the biofluid material is pumped to the next reservoiralong the secondary path, as indicated by a block 1018. The process thenflows to a block 1020 in order to analyze the results at each secondaryreservoir and, if there is a positive result, as indicated by block1022, the process is terminated at a block 1024. If the result is notpositive, the process then flows to a block 1026 to determine if that isthe last testing reservoir and, if so, the process flows to theterminate block 1024. If there are more testing/analysis blocks throughwhich to process the biofluid material, the process then flows to block1028 and back to the input of a block 1018 to pump the biofluid serialto the next testing reservoir.

Referring now to FIG. 11 , there is illustrated a flowchart for theloading operation, which is initiated at a block 1101 and then flows toa block 1102 wherein the sample is placed in the well and then to adecision block 1104 to determine if this is a process wherein thebiofluid sample is to be mixed with some other diluted product or anaffinity label. If it is to be mixed, the process flows to a block 1106to mix the biofluid sample and, if not, the process bypasses this step.The process then flows to a block 1108 in order to activate the pump andtransferred the biofluid material after mixing to the next reservoir inthe process.

Referring now to FIG. 12 , there is illustrated a flowchart for theprocess of the cell counting operation, i.e., the operation at theviewing reservoir. This is initiated at a block 1202 proceeds to a block1204 in order to transfer the biofluid material to the viewing chamber.The process enclosed a block 1206 in order to view the cells in realtime as they pass through the various microchannels and viewing window.The process then flows to a block 1208 in order to count the cells. Atthis stage, the cells can have various affinity labels associated therewith such that the target cells can be viewed and discriminated betweenbased upon the affinity labels associated therewith. If, for example,there were multiple types of bacteria contained within the biofluidsample and each of these types of bacteria had associated therewithdifferent affinity label that clips arrest at a different color, theykilled be discriminated between. Additionally, proteins would have adifferent affinity label than a bacteria and this would also allowdiscrimination between the two types of cells. The process then flows toa block 1210 to store the transferred biofluid in the reservoir and intoa block 1212 to terminate.

Referring now to FIGS. 13A-13C from their illustrated variousconfigurations for the cell counting operation. In the first embodimentof FIG. 13A, there are provided a three-part microchannel 1302, a middlesection microchannel 1304 and an outlet microchannel section 1306 themiddle section 1304 has a diameter that is slightly larger than thelargest cell that could be contained within the biofluid. This allowsthe cells to be transferred in a more orderly manner. The cell viewingwould be performed at this middle section microchannel 1304. In theembodiment of FIG. 13B, there are provided three varying diameter middlemicrochannel sections 1308, 1310 and 1312, each with different diametersto allow different size cells to flow therethrough. This type ofembodiment may facilitate some selection in the cells for viewing. Inthe embodiment of FIG. 13C, there is illustrated the above discloseembodiment wherein the microchannel 416 empties into the reservoir 418and the viewing is basically performed upon the cells within thereservoir 418.

Referring now to FIG. 14 come there is illustrated a flowchart for theparallel cell capture in the first testing/analysis stage. This isinitiated at a block 1402 and a process and proceeds to a block 1406 inorder to preload all of the cell capture areas having reagent associatedthere with, such that the portion of the biofluid stored in thereservoir 418 is transferred to the reservoirs associated with theparallel cell capture areas. The process enclosed a block 1408 whereinthe pump is activated to fill all of the cell capture wells associatedwith this stage of testing/analysis. The process then flows to a block1410 to possibly allow the cells to slowly go through the microchannelsin order to interact with the reagent. If so, this requires a certainamount of time and this would result in the micropumps operating at alower rate to allow sufficient time for the cells to flow through theserpentine microchannels 316 to interface with the particular coating onthe surfaces thereof. This basically is the amount of time required forthe micropumps to fill up the reservoir 318 associated there with. Thelength of the serpentine microchannel 316 would determine the amount oftime required to fill up the reservoir 318. Once the reservoir has beenfilled, as indicated by a block 1412, then the viewing window in thereservoir 318 is analyzed, as indicated by a block 1414. The path fromthe block 1410 to the input of the block 1414 indicates a path by whichthe micropumps can be run at a higher rate. The process then isterminated at a block 1416.

Referring now to FIG. 15 , there is illustrated flowchart for the secondphase of the analysis, provided that the first phase indicated apositive result for one of the cell capture areas and the associatedreagent. This is initiated a block 1502 and then proceeds to a block1504 to preload all of the secondary cell capture areas with reagent andinto a function block 1506 to pump all of the remaining biofluidmaterial from the reservoir 418 into the first reservoir in thesecondary reservoirs 330. This also goes through and incubate step toallow the micropumps to pump at a slower rate to allow the biofluidmaterial to go through the serpentine microchannel 316 at a slower ratebefore it enters the associated reservoir 318. When the reservoir 318 isfilled, as indicate a by block 1510, the contents of the reservoir 318are analyzed at a block 1512. If the pump can be run at a faster rate,this is provided by a path around the block 1510. If the result ispositive, as indicated by a block 1514, then the process is terminatedat a block 1516. If not, the process flows from the block 1514 to ablock 1518 in order to the next reservoir 330 in the back to the inputof the serpentine microchannel 316 and then float the input of the block1508.

Referring now to FIG. 16 , there is illustrated a simplifieddiagrammatic view of the microfluidics chip for processing a pluralityof modules. The sample 303 is input to the well 302 and then pumped intothe viewing window 306. A waste microchannel 1602 is provided aninterface to the viewing window 306 that is interfaced with a microvalve 1604 to allow air to escape, or any bubbles that may be present,from the viewing window 306. Additionally, the waste microchannel 1602could interface with an external vacuum source aid in fluid flow. A cellcounter/discriminator 1606 is provided for optically viewing thecontents of the viewing window 306, the output thereof processed via aprocessor 1608. The outlet of the viewing window 306 is interfaced witha manifold microchannel 1610 through a connecting channel 1612. At thispoint, the micro valve 1604 is closed such that the biofluid containedwithin the viewing window 306 and the interfaced with microchannelmanifold 1610 to allow fluid to be pump therefrom to a plurality ofdistribution paths along distribution microchannels 1614. It may be thatpump 304 would need to be activated in order to reduce the pressure atthe upper end of the viewing channel 306 or, alternately, a microchannel1618 interfaced with a micro valve 1620 could be provided to, when open,relieve the pressure in the upper end of the viewing window 306 to allowbiofluid to be pumped therefrom to the microchannel manifold 1610.

Each of the distribution microchannels 1614 is interfaced with aseparate module via an associated distribution pump 1624 to interfacewith and associated one of modules 1625, labeled A-Z, for example. Therecan be any number of modules provided. However, each module 1625 hasassociated there with a finite capacity and, therefore, the number ofmodules 1625 that can be interfaced to the viewing window 306 is afunction of the volume of biofluid contained therein and the capacity ofthe reservoirs of each of the individual modules 1625, each of theindividual modules 1625 potentially having a different capacity,depending upon the configuration thereof. However, selecting among thevarious distribution pump 1624 can allow desired tests to be done withthe available biofluid contained within the viewing window 306.

Referring now to FIG. 17 there is illustrated a diagrammatic view of oneof the modules 1625 associated with the parallel testing configuration,wherein biofluid is loaded into a plurality of testing reservoirs. Thedistribution pump 1624 associated there with transfers fluid from thedistribution microchannels 1614 to an intermediate microchannel manifold1702 which is then interface with a plurality of testing reservoirs 312,as described hereinabove. Each of these testing reservoirs has aserpentine microchannel 316 and a viewing window 318 associated therewith. As described hereinabove, each of these testing reservoirs canhave a different volume and a different configuration mechanically andcan be associated with a different test. They can each have a particularcoating of reagent, such as an antibiotic, to interact with the biofluidfor testing purposes to determine if there is any reaction of thebiofluid in the cells contained therein to the material coated on thesides of the serpentine microchannels 316. In the operation of thisparticular module 1625, all of these testing reservoirs 312 areassociated with different reagents and will be loaded in parallel. Forthis embodiment, will be desirable for each of the reservoir 312 to havethe same volume. If, however, they had different volumetric capacities,it would be necessary to have some type of waste gate with a micro valveto allow all of the viewing windows 318 to achieve full capacity.

Referring now to FIG. 18 , there is illustrated a diagrammatic view ofthe serial wherein a plurality of testing reservoirs 330 is arranged ina series configuration. In this configuration, the associateddistribution pump 1624 will transfer biofluid from the microchannelmanifold 1610 through the distribution microchannels 1614 to the firstof the testing reservoirs 330. The biofluid will be contained within theviewing chamber 318 and, as noted hereinabove, there will be possible hesome type of waste microchannel associated micro valve to allowair/bubbles to escape during filling of the viewing window 318.Thereafter, a second serial pump 1706 is activated to transfer thecontents of the viewing window 318 to a second testing reservoir 330 inthe associated serpentine microchannel 316 and viewing window threeeight teen. In this transfer, there may be required a reliefmicrochannel (not shown) at the inlet end thereof to reduce the pressuretherein during the pumping operation. This will continue until all ofthe tests have been done. Each of the serpentine microchannels 316associated with each of the testing reservoirs 330 will have a graduatedincrease in the particular reagent to determine the dosage, in thisexample. It may be that, upon being exposed to the dosage of the reagentin the first testing reservoir 330 that cellular material in thebiofluid is somewhat affected by the reagent, i.e., the antibiotic, forexample. By moving to a higher concentration of the reagent in the nextsequential testing reservoir 330, this could be accounted for in theoverall analysis. It may be that the actual concentration in the nextsequential testing chamber 330 is not an exact incremental increase inthe reagent. For example, if it was desired to expose the biofluid toreagent increments of 10%, 20%, 30%, etc. in 10% increments, it may bethat the first testing chamber 330 has a concentration of 10% and thenthe second testing chamber has a concentration of possibly 16%,accounting for the fact that the accumulated effect of passing throughthe 10% testing chamber 330 and the 16% testing chamber 330 effectivelyprovides a 20% accumulated exposure in the second testing chamber 330and so on.

Referring now to FIG. 19 , there is illustrated a diagrammatic view of aconfiguration for providing parallel loading of the serial configurationfor the incremental testing. This is similar to the embodiment of FIG.17 , except that the testing chambers 330 are all interfaced with theassociated distribution pump 1624 through a microchannel manifold 1902in a parallel configuration, such that they are all loaded at the sametime, with each having a different concentration of reagent associatedthere with. In this configuration, however, since all of the testingchambers 330 will be loaded in parallel, there are required to be asufficient volume of biofluid contained within the viewing window 306initially to facilitate complete filling of each of the associatedviewing windows 318.

Referring now to FIGS. 20A-20B come there is illustrated a diagrammaticview of chemostat, wherein the associated distribution pump 1624transfers biofluid from the distribution microchannel 1614 two eightchemostat 2002. The details of the chemostat 2002 are illustrated inFIG. 20B. A main microchannel 2004 is interfaced on one and thereof withthe output of the distribution pump 1624 associated there with, with theother end of the microchannel 2004 interfaced with a waste gate via amicro valve (not shown). There are a plurality of cell storagemicrochannels 2006 connected between one surface of the mainmicrochannel 2004 and a waste microchannel 2008. Each of these cellstorage microchannels 2006 associated there with a filter 2010 disposedat the end thereof proximate to the waste microchannel 2008. Each of thecell storage microchannels 2006 has a size that will receive aparticular target cell having a particular dimension, such that thetarget cell will flow into the cell storage microchannel and cells ofsmaller size will pass through the associated filter 2010, which filter2010 is a microchannel with a diameter that is smaller than that of thetarget cell. This waste material will flow out through the waste gate ormicro valve (not shown) associated with the waste microchannel 2008. Bymaintaining a pressure differential between the main microchannel 2004and the waste microchannel 2008, the target cells will be stored withinthe cell storage channels 2006. Larger cells than the target cells inthe main microchannel 2004 will bypass the cell storage microchannels2006 and pass out of the waste gate associated with the mainmicrochannel 2004, keeping in mind that there is required to be a lowerpressure within the waste microchannel 2008 as compared to the mainmicrochannel 2004.

Referring now to FIG. 21 , there is illustrated an embodiment of themicrofluidic chip utilizing micro valves as opposed to intermediatemicropumps. In this embodiment, there are illustrated a plurality ofinput wells 2102 for interfacing with an initial micropump 2104 to pumpfluid through a viewing window 2106 to a first reservoir 2108. Havingmultiple wells 2102 allows multiple samples to be input through theviewing window 2106 or to actually mix two different materials togetherfor flowing through the viewing window 2106 to the reservoir 2108. Thewaste gate 2110 can be provided at the reservoir connected thereto via awaste microchannel 2112 to allow air/bubbles to escape. A micropump 2114is operable to pump fluid from the reservoir 2108 to a main microchannelmanifold 2116. During this pumping operation, some type of pressurerelief is required which can either be provided via one of the pumps2104 being activated or a relief micro valve 2118 Interface with theinput end of the viewing window 2106 through a relief microchannel 2120.

Interfaced with the main microchannel manifold 2116 is a plurality ofdistribution micro valves 2124. These distribution micro valves 2124 canbe interfaced with various modules, as described above herein withrespect to FIGS. 17-20A/b. The only difference is that the associateddistribution pump 1624 has been replaced by a distribution valve 2124.Additionally, each of the parallel loaded testing reservoirs 312 can beindividually associated with one of the distribution valves 2124 toselectively certain ones thereof for testing. Since each one of thesetesting reservoirs 312, after selection, is required to be completelyfilled, by allowing individual selection of the testing reservoirs 312,certain ones thereof can be eliminated. It may be that, in pre-analyzingthe biofluid sample, it can be predetermined that certain ones of theassociated reagents in the reservoir 312 are not required thetesting/analysis step and can therefore be eliminated from the step offilling. This is opposed to the embodiment of FIG. 17 , wherein all ofthe testing reservoirs 312 are complete the filled.

Referring now to FIGS. 22A-22B, there is illustrated cross-sectionalviews of a micro valve in an open and a closed position. The substrate402 has cover plate 440 disposed on top thereof. There are provided tomicrochannels 2202 and 2204 that are to be connected together with themicro valve. The microchannel 2202 is interfaced with a hole 2006 to thesurface of the cover plate 440 to an opening 2208. The microchannel 2204is interfaced to a hole 2210 to an opening 2212 in the cover plate 440.The micro valve has a fixed body 2214 with a membrane 2216 disposed onthe surface there above to define a pumping chamber 2218. The pumpingchamber 2218 has a hole 2220 interfacing the pumping chamber 2218 withthe opening 2208 on the cover plate 440. Similarly, the hole 2212 isinterfaced to the pumping chamber 2218 through a hole 2222. The membrane2216 is operable to reciprocate away from the surface of the fixed body2214 exposing the top of the hole 2210 in the pumping chamber 2218 toallow fluid to flow through the pumping chamber 2218 and down throughthe opening 2222 through the cover plate 440 and through to themicrochannel 2204. In the closed position, the membrane 2216 is forceddown against the upper end of the hole 2220. A pneumatic cavity 2230 isdisposed above the membrane 2216 in a housing 2232 and interfaces with apneumatic source through a hose 2234. Thus, by drawing a vacuum in thepneumatic cavity 2230, the membrane 2216 will be pulled away from thehole 2220 to allow fluid to flow and, when pressurized air is forcedinto the pneumatic cavity 2230, and the membrane 2216 is forced down tothe surface of the fixed body 2214 to seal the opening 2224 in a closedposition.

Referring now to FIG. 23 , there is illustrated a process flow forpreparing the biologic sample for the microfluidic chip 102. Thepreparation of the biologic sample can take many forms. In this example,the raw biologic sample can be preprocessed, depending upon the type ofsample that is being considered. For example, if blood is being tested,the Complete Blood Count (CBC) can be determined, as well as the WhiteBlood Cell Count (WBC), the liver functions and the kidney functions.For urinalysis, the sample can be prepared for testing for WBC's andnitrates, as well as proteins and Bilirubin. There are many well-knownprocesses for preparing biologic samples prior to testing. Once thebiologic sample has been prepared a, affinity labels are attachedthereto. Typically, there will be a vial 2302 provided with the biologicsample that is mixed with affinity labels in a vial 2303 resulting inthe vial 2304 containing a labeled sample. These labels are sometimesreferred to as “affinity labels” or “microspheres.” These functionalpolymeric microspheres typically have a diameter of less than 5 μm andhave been developed for use with immunological methods. The reagentswere initially used as visual markers to identify specific cell typesand analyze the distribution of cell surface antigens by scanningelectron microscopy. They have also been used, due to their inherentproperties, two separate labeled from unlabeled cells by techniques suchas centrifugation, a electrophoresis, magnetic chromatography andfluorescence cell sorting. The cells contained within the biologicsample are basically cells bearing defined antigens or receptors,ligands which bind with a high degree of selectivity an affinity tothese cell surface sites. The microspheres interact with the specificligand, which can allow for separation based upon the characteristicproperties of the microspheres. This allows for displaying of theselabeled cells with the target receptor or antigen with antibiotics orother ligands directly or indirectly bound to the microspheres. Specifictypes of microspheres or affinity labels can be the type that willfluoresce at a particular wavelength. Thus, specific cells can beidentified the optical techniques to identify target cells ordifferentiate between various types of, for example, bacterial cells andproteins, etc. This labeled sample is then disposed within the well 302on the microfluidic chip 102 for later processing.

Referring now to FIG. 24 , there is illustrated a side cross-sectionalview of an RT-lamp. The RT-lamp is a Reverse Transcription Loop-mediatedisothermal Amplification device, which is a technique for theamplification of RNA. This combines the advantages of the reversetranscription without of the LAMP technique. The LAMP technique is asingle to technique for the application of DNA. This technique is anisothermal nucleic acid application technique, in which a chain reactionis carried out at a constant temperature and does not require a thermalcycler. The target sequences animal five at a constant temperature usingeither two or three sets of primers and polymerase with high stranddisplacement activity in addition to a replication activity. Theaddition of the reverse transcription phase allows for the detection ofRNA and provides a one-step nucleic acid amplification method that isused to diagnose infectious diseases caused by bacteria or viruses.

FIG. 24 illustrates an example in which a multimode instrument 2401 iscoupled to a smartphone 2402. The smartphone 2402 includes an LED 2404and a camera 2406. The camera 2406 includes an image sensor, such as aCCD. The instrument 2401 includes a sample chamber 2408 for receiving anoptical assay medium. The optical assay medium comprises the labeledbiologic sample disposed within the viewing window 306 on themicrofluidic chip 102. The sample chamber 2408 may include a door 2432that prevents stray light from entering.

The optical assay medium is positioned over a detection head 2412 in thesample chamber 2408. The instrument 2401 includes an optical output pathfor receiving an optical output from the optical assay medium in thesample chamber 2408 via the detection head 2412. The optical output pathmay include a multimode fiber 2414 that directs light from the detectionhead 2412 to a cylindrical lens 2416. The optical output path mayfurther include a wavelength-dispersive element, such as a diffractiongrating 2418, that is configured to disperse the optical output intospatially-separated wavelength components. The optical output path mayalso include other optical components, such as collimating lenses,filters, and polarizers.

The instrument 2401 can include a mount for removably mounting thesmartphone 2402 in a working position such that the camera 2406 isoptically coupled to the optical path, for example, in a predeterminedposition relative to the diffraction grating 2418. In this workingposition, the camera 2406 can receive at least a portion of thedispersed optical output such that different locations are received atdifferent locations on the image sensor.

The instrument 2401 may also include an input optical path for directinglight from a light source to the optical assay medium in the samplechamber 2408, for example, through the detection head 2412. In someinstances, the LED 2404 on the smartphone 2402 could be used as thelight source. To use the LED 2404 as the light source, the input opticalpath may include a collimating lens 2420 that receives light from theLED 2404 when the smartphone 2402 is mounted to the instrument 2401 inthe working position. The input optical path may further include amultimode fiber 2422 that directs the light from the collimating lens2420 to the detection head 2412. The input optical path may also includeother optical components, such as collimating lenses, filters, andpolarizers.

The instrument 2401 may also include an additional input optical paththat directs light form an internal light source, such as a laser 2424,to the optical assay medium in the sample chamber 2408. The additionalinput optical path may include a multimode optical fiber 2426, as wellas collimating lenses, filters, polarizers, or other optical components2428.

Referring now to FIG. 25 , there is illustrated the view of the RT-lamp2401 with a microfluidics chip 102 disposed within the sample chamber2408.

Referring now to FIG. 26 , there is illustrated a side view of the smartphone 2402 interfaced with the microfluidic chip 102 four imaging thesurface thereof, which is illustrated in a window view in FIG. 27 . Thiswindow view illustrates the viewing window as a box 2702 in which theimage of the microfluidic chip 102 is displayed. The applicationautomatic the recognizes various markers 2704, 2706 and 2708 one threecorners thereof. This will allow orientation of the window with respectto the application. A box 2710 in phantom dashes will be oriented by theapplication running on the smart phone 2402. Once the box has beenoriented visually about the image of the microfluidic chip 102, thenprocessing can proceed. The processing is basically focusing upon thechip to gain the best optical image of the target sites. The targetsites are storage reservoirs 312 and 330, for example. Each of thesewill have a viewing well 318 associated there with an these viewingwells 318 will have, and one example, a process biologic sample havingaffinity labels associated there with that fluoresce. By recognizing theflorescence, the presence of the cell can be determined. The lack offlorescence indicates that the cell, a bacteria for example, has beendestroyed. This can be a positive test. By examining at each stage ofthe testing process the chip, a determination can be made as to resultsin essentially real time. This will be described in more detailhereinbelow. Once the image is believed to be in focus, then the usercan actually take the picture or the application cell can automaticallydetermine that the focus is adequate and take that. This is very similarto character recognition techniques that are utilized in recognizingfaces in camera images received by the phone.

Referring now to FIGS. 28A-28H, there are illustrated various images ofthe microfluidic chip 102 at different stages, this view being adiagrammatic view for simplicity. In this view, there is provided thesample well 2802 which then feeds into the viewing well 2804. Asdescribed hereinabove, there are multiple pumps that allow fluid to bemoved from the sample well 2802 over to the viewing well 2804 and theseare not shown force simplicity purposes. There is provided a multiplexer2806 which represents the micropumps/valves described hereinabove. Themultiplexer 2806 may be associated with one bank 2808 of reservoirs 2802for the parallel processing stage. These reservoirs 2012 correspond tothe reservoirs 312. This requires that the multiplexer 2806 distributefluid to a microchannel manifold 2810 and one testing phase. Themultiplexer 2806 also is connected via a plurality of microchannels to abank of reservoirs 2814 associated with the serial processing stage toselectively distribute fluid to one of the strings in a second testingphase. This bank of reservoirs includes the reservoirs 330 describedhereinabove. Each of these reservoirs 330 is arranged in series suchthat each has a valve or pump 2816 disposed there between. Themultiplexer 2806 also interfaces with a bank 2820 of reservoirs, these,in this example, associated with the serial testing/analysis stage andhaving reservoirs 330 associated there with. In this example, there areprovided five test reservoirs in the bank 2808, wherein each of thesetest reservoirs has associated there with one serial string of testreservoirs 330 in the bank 2814 and one parallel loaded string ofreservoirs 330 in the bank 2820. Additionally, there is a separatetesting reservoir 2824 which could correspond to the cell storage areautilizing a chemostat described hereinabove, which is interfaced withmultiplexer 2806 through a microchannel 2826.

Referring now to FIGS. 28B-28H, there are illustrated various stages ofthe loading and analysis. FIG. 28B illustrates the first step in theprocess wherein the biologic sample is loaded into the viewing window2004. That the step in the process, the microfluidic chip is disposedwithin the RT lamp 2401 and analyzed to determine the number of cellsand the type of cells. If, for example, a certain bacteria were beingtested for on this particular microfluidic chip 102, the lack ofbacteria cells, as indicated by the particular affinity labels thatwould be attached to these particular bacteria cells, would indicatethat further testing is not required. However, if the correct cells arelabeled and the number of cells is at an appropriate level for testing,then the next step of the process is taken.

FIG. 28C illustrates a next step of the process wherein a portion of thecontents of the viewing well 2804 are transferred to all of thereservoirs 28 one two in the bank 2808, there being five reservoirs 2812disposed therein, the indirect dies that there could be more reservoirs2012 provided on the microfluidic chip 102. There will be a certainamount of time required for the pump associated with the multiplexer2806 to actually move the desire portion of the biologic sample throughthe manifold 2810 to the reservoirs 2812. As noted hereinabove, each ofthe reservoirs 2812 corresponds to the reservoirs 312, each having aserpentine microchannel 316 and a viewing reservoir 318 associated therewith. The micro pumps associated with the multiplexer 2806 and, nationwith the very small widths of the microchannels can require this processto take upwards of 10 or 20 minutes. After this period of time, themicrofluidic chip 102 can be imaged to determine if the cells have beendestroyed by the coating on the surfaces of the serpentine channel 316.(It should be noted that the viewing well 318 could also be coated). Ifthe cells are destroyed, this indicates that the reagent that coats thewalls of the microchannel associated with the reservoirs 312 reacted ina manner indicating self-destruction. However, any visual indication inthe viewing wells that can be a vehicle for discrimination betweeninteraction with the particular reagent coating the walls of theserpentine microchannels 316 will provide the ability for a decision tobe made as to which reagent is required for further testing.

FIG. 28D illustrates the next phase of operation, which is the phase inwhich the dosage level is term and. In the example above, the middlereservoir in the bank 2808 provided a trigger indication that triggereda decision to then test for dosage in the middle string within the bank2814. This will require a multiplexer 2806 two only transfer theremaining portion of the biologic sample from the viewing reservoir 2804into this particular string. As described hereinabove, this process willinvolve first passing of fluid to the first reservoir 330, which willtake a certain amount of time to actually pump the biologic samplethrough the microchannels into the viewing window 318. This can be amultiphase process, which requires viewing at each stage. In thisparticular example, the third stage of testing in this middle string inthe bank of reservoirs 2814 resulted in a perceivable result, i.e., alack of florescence, for example. At this point, the image will actuallyshow the perceivable result in both the bank 2808 and in the bank 2814.Thus, in the three phases of testing, the particular cells have been adefined, an indication has been provided as to which of multiplereagents that could possibly provide the desired therapeutic resultswould be the best choice for the patient and then the third phase oftesting provides the actual dosage of that determine reagent. It may bethat for ten individuals that had exactly the same symptoms andprocessed a similarly processed biologic sample for testing in the sameway with the microfluidic chip and the RT-lamp 2401 came up withdifferent results. Each individual's particular physiology can vary and,as such, the results could differ. In a typical medical environment, theparticular reagent of choice or drug of choice is determined by anindividual based upon various criteria. Since the medical professionaldoes not have the test directly in front of them, they might justprescribe, for example, a broad based antibiotic. They might follow thatup with testing of a biologic sample in a lab, which could take a numberof days just to determine exactly what bacteria is present and whatwould be the best antibiotic to use in order to attack this particularbacteria. Of course, the broad-spectrum antibiotic might have worked bythe time the test results come back. If not, these results might beuseful to the medical professional. However, these tests seldom if everactually focus in on the dosage that would be preferable for aparticular individual. If even the particular antibiotic could beidentified which was specific to that particular bacteria tested for andfound be present in the biologic sample, the dosage prescribed istypically a medium or high dosage, depending upon the criteria that themedical professional utilizes. However, the medical professionaltypically generalizes the physiology of any individual and maybe filtersthat based upon age, gender, etc. However, the individual physiology isnot taken into account.

With use of the present microfluidic chip 102, the entire testingprocess can be performed at the Point of Care (POC) in a relativelyshort amount of time. The result is not only the identification of thebest reagent to use but also the dosage. This is all accomplished with avery small amount of biologic sample.

FIG. 28E, there is illustrated a potential further processing that canbe provided. In this embodiment, the bank 2820 can have a differentmodification of the antibiotic that was determined from the testassociated with the bank 2808. This modification could be associatedwith the pH of the antibiotic, wherein it has been determined withrespect to some antibiotics that the pH of the antibiotic can affect theefficacy thereof. In this example, it can be seen that the thirdreservoir with respect to dosage is the one that is selected in the bank2814 but in the bank 2820, is the lowest dosage. Thus, the multiplexer2806 needs to first test the bank 2814 and then test the bank 2820.However, it should be understood that both the bank 2814 and the bank2020 could be identical, either serially loaded or parallel loaded, thecommonality being that they have a gradually increasing dose ofantibiotics that can be tested for.

FIGS. 28F-28G, there are illustrated two additional examples of twodifferent patients with substantially the same symptoms and utilizingsubstantially the same process for preparing the biologic sample. Withrespect to FIG. 28F, the fifth reservoir and the antibiotic associatedthere with exhibited the highest efficacy at the highest dose as todestroying the particular bacteria, in the example of the bacteria. Theassociated dosage determined from testing the biologic sample in thebank 2814 was considered to be the second level of dosage. In the bank2020, the third level of dosage was considered to be the lowest dose.With respect to FIG. 28G, the first reservoir and the antibioticassociated there with was considered to have the highest efficacy withrespect to dealing with the particular bacteria and it was the lowestdose in that case when tested in the bank 2814, as compared to thefourth level dosage in the bank 2820. It can be seen thus that differentpatients will have different “fingerprints” associated with the testingof the same biologic sample repaired and substantially same way.

FIG. 28H, there is illustrated an alternate embodiment wherein the testperformed at the bank 2808 resulted in a slight ambiguity in that thebacteria were killed in two other reservoirs. In this case, theindication would be that either of these antibiotics would work againstthis particular strain of bacteria. Thus, the next phase the test wouldrequire the multiplexer 2806 to distribute the contents of the reservoir2804 through the microchannels to actually two different strings. Thus,for this type of test to be carried out, it is important that there besufficient volume in the viewing window 2804, i.e., sufficient amount ofbiofluid introduced to the well 2802, in order to fill both of thesereservoirs and allow the testing to progress down to the highest dosagelevel in either or both of the banks 2814 and 2820. The results of thistest show that, for the rightmost reservoir in the bank 2808 having beendetermined to be effective at the highest dose, the next of the lastdosage was required in order to achieve the desired results, whereas thenext to the left reservoir in the bank 2808 having been determined to beeffective at the highest dose required only the smallest dose to achievethe results. Therefore, this test shows that, although two antibioticswould work, one would actually work with the lower dose.

It should also be understood that, in addition to the test beingdifferent for the same strain of bacteria in a biologic prepared mensubstantially the same way, it should also be understood that thisparticular set of results could be different for different strains ofthe same bacteria. It may be that, for one strain, one antibiotic wouldwork at a particular dose and, for another strain of the same bacteria,a different antibiotic work or just a different dose of the sameantibiotic. The microfluidic chip described and disclosed in the presentdisclosure allows this determination to be made utilizing a singlesample in a parallel/serial testing method at the POC wherein the firststep or phase of selection is made among a plurality of potentialantibiotics that could arguably target different bacteria and, once adetermination is made at the first phase, then the next and serialdecision is made to determine dosage at a second phase.

Referring now to FIG. 29 , there is illustrated a flowchart depictingthe overall analysis process. The process is initiated at a block 2902and then proceeds to a block 2904 wherein the biologic sample isprepared. As described hereinabove, this preparation involves labelingthe cells within the biologic sample so that they can be discriminatedbetween or identified. It may be that there are a number of differenttypes of cells such as bacteria of different strains and types,proteins, etc. Different affinity labels can be applied such thatmultiple cells of different types can be identified. The process thenflows to a block 2906 wherein the biologic sample is placed into thesample well and then passed on to the viewing well. At this point, themicrofluidic chip is placed into the RT-lamp and optically analyzed, asindicated by process block 2908. It is at this point in the testingphase that the identification process will identify the potential targetcells. Since each of the microfluidic chips has a finite number ofreservoirs associated there with for the purpose of testing, the coatingis applied to these particular reservoirs for the specific antibioticsor reagents to be tested may not be useful for testing the particularcellular structures that have been identified at this step in theprocess. However, it should be understood that the number of differentbanks of testing reservoirs that can be provided on a particularmicrofluidic chip can be expandable and the could actually be providedfor multiple different types of reagents. For example, one set oftesting banks may be associated with UTI and another associated withstreptococcal bacteria. Recognizing these at this step in utilizing themwith a microfluidic chip that can test for both types of bacteria willallow the particular biologic sample, which is quite small, to be routedto the appropriate reservoirs for testing for that specific identifybacteria.

The decision to proceed is determined at a decision block 2910 and, iftesting can proceed with the current microfluidic chip, the processproceeds to a block 2911 to select the particular test that are to beperformed. The process then proceeds to sequence through the tests, asindicated by a block 2914. This sequencing sequences through the variousphases, with the initial test being selected first, as indicated byblock 2916. In the above examples, this is the first parallel phase todetermine which among several reagents is most effective against theparticular cellular structure of interest. The process and proceeds to ablock 29 eight teen in order to analyze the results of this initial testand then to a decision block 2920 to determine if more tests arerequired or if this is the only test. If the test is negative at thisstage and none of the reagents provides any effectiveness indication,the process is terminated or, if this is the last test, the process isterminated. The process, if continued, then selects the next test in thesequence and proceeds back to the input of the block 2918 to continuesequencing through the tests.

Referring now to FIG. 30 come there is illustrated a flowchart for thetesting process. This is initiated at a block 3002 and then proceeds toa block 3004 two first pump a portion of the biologic sample stored inthe viewing window through to the parallel reservoirs and load all ofthe parallel reservoirs for testing/analysis. This may take upwards of10 or 20 minutes, due to the fact that the micropumps utilized arerelatively slow and the diameter of the microchannels is small, thusrestricting high flow rates. The process then flows to decision block3006 to determine if there is been any positive result, i.e., is thereany indication that any of the reagents provide an effectivenessindication, either through some color change or the lack of colorindicating the destruction of the cells. If there is no result, then theprocess is terminated in the process flows to a function block 3008 twoselect the next test path that is associated with the antibiotic havingbeen tested as being effective in the first phase of operation/testing.A process block 3010 and indicates that a graded dosage test path isselected, either the one for loading parallel or the one or loadingserially. It should be understood that the parallel loaded graded dosagetest path requires all of the reservoirs to be completely filled fromthe reservoir associated with the viewing window. The serial path, bycomparison, allows all of the contents of the viewing window in thereservoir associated there with to be disposed in each reservoir andthen sequentially transferred to the next reservoir down the chain andat the higher dosage. However, it should be understood that the systemcan be configured such that the first reservoir at the lowest dosage isloaded with only a portion of the contents of the viewing window and thereservoir associated there with, analyzed and then a micro valve gateopened to allow the micropumps for pumping fluid to the serial path tooperate to continue pushing more biofluid through the first reservoir,thus filling the second and reservoir and so on. In this process,sufficient biofluid must be contained within the viewing window and thereservoir associated there with in order to allow for filling of all ofthe reservoirs down to the highest dosage rate associated with thatserial string.

In the process, the serial string will first select the lowest gradeddose reservoir and a process block 3012 and then pump biofluid to thefirst reservoir and a process block 3014, analyze the results a processblock 3016, understanding that it could take 10 to 20 minutes to filleach reservoir. A determination is made at a decision block 3018 as towhether there is a positive result, i.e., was there and an effectivenessdetermination made at this point, and, if so proceed to a decision block3020 to determine if there are any higher concentrations to be testedfor. If so, the next reservoir selected by opening gate or activating amicropump, as indicated by a process block 3022, and the proceed back tothe process block 3014 in order to pump to this reservoir.

In the parallel process, a process block 3026 indicates an operationwherein the micropump pumps sufficient biofluid material to the parallelrated reservoirs to fill all of the reservoirs and into a process block3028 in order to analyze the results.

In some embodiments, a biological specimen (i.e. saliva, blood, urine,semen, feces) may be provided by a user onto an analog testing device.The analog testing device may be used for testing strep (i.e. strep A,strep B, rapid strep), TP/INR, chronic conditions, MERS (Middle EasternRespiratory Syndrome), diabetes, urinary tract infection and analysis,influenza, pregnancy, HIV, malaria, immunology, blood glucose,hemoglobin, blood electrolytes, cholesterol, fertility, troponin,cardiac markers, fecal analysis, sperm viability, food pathogens,HemoCues, CRP (put them in), dengue fever, HBA1C (put them in),Homocystein, salivary assay, drugs of abuse, drug interaction,infectious diseases, viral loads, tuberculosis, allergies (i.e. food andenvironment), Lyme disease, Methacillian-resistent MRSA, Staphylococcusareas, sexually transmitted diseases, thyroid stimulating hormone (TSH),lipid profile, INR (put them in), TEG, magnesium, lactate,transcutaneous bilirubin, Helicobacter pylori, bacteria, cell count,cancer markers, tumor markers, resistant Staph aureus, antibioticresistance, stroke markers, sepias markers, DNA markers, parathyroid,renal, or any other type of analog testing device that utilizes abiological specimen to determine a user's disease, disability,discomfort or dissatisfaction state of health. In some embodiments, theanalog testing device may be compact and hand-held. In some embodiments,the analog testing device may be a standard stand-alone device.

In some embodiments, the user may take a sample of the biologicalspecimen and transfer the biological specimen to an input of the testingdevice. The input of the testing device may include an input window thatguides and holds the biological specimen securely within the analogtesting device. In some embodiments, more than one window may beprovided on the analog testing device to accommodate more than onebiological specimen. For instance, the analog testing device may includetwo windows for a pregnancy test, in which one window may be provided toreceive urine to test for the presence of HCG and a second window may beprovided to receive urine to test for urinary tract infection bacteria.In some embodiments, multiple analog testing devices with one or moreinput windows may be used to detect the biological specimen. In someembodiments, the analog testing device may include a results displaywindow indicating a positive or negative sign, a color spectrum, a line,a circle, a curve, a balloon, a signature marker, or variance of thelike. The results may be mathematical, geometrical, color spectral,light spectrum, cell multiplication, or the like. The display window mayindicate the completion of the test, an error, the test results or acombination thereof.

In some embodiments, the user may capture the results on the resultsdisplay window via a mobile computing device, for instance in the formof audio, video, photo, scan, or a combination thereof. The mobilecomputing device may include one or more peripheral devices, forinstance, an image scanner, microphone, video recorder, digital camera,speakers, and the like, to capture the results from the analog testingdevice and convert the results into a digital data package.

FIG. 31 illustrates a diagrammatic view of a biofluidic analysis system3100 in accordance with various embodiments of the present disclosure.The system 3100 may include a mobile device 3102. The mobile device 3102may be a mobile handheld user device, such as a smart phone, tablet, orthe like. The mobile device 3102 may include a processor 3104, a memory3106, an input/output (I/O) interface 3108, a display 3110, and acommunication interface 3112 all connected via a bus 3114. Thecommunication interface may connect the mobile device 3102 to outsidesources, such as a server 3116 having a database 3118 associatedtherewith, over a network 3120, i.e. a cellular network or Internetnetwork. The memory 3106 may store an operating system 3122 and variousspecial-purpose applications, such as a browser by which webpages andadvertisements are presented, or special-purpose native applications,such as weather applications, games, social-networking applications,shopping applications, and the like. The digital data package mayprovide data to a special purpose native application 3124 stored in thememory 3106, the application 3124 having associated therewith anapplication programming interface (API) 3126. The digital data packagemay be obtained by the mobile device 3102 by an test results capturemodule 3128 connected to the processor 3104. The test results capturemodule 3128 may capture an image, scan, video, or other digital media ofa testing device 3130, converting the analog biologic sample testingdevice and the results presented on the device to a digital format andto create a unique identifier that can be used to trigger a plurality ofevents.

The unique identifier comprising the digital data package may beanalyzed by the application 3124 to determine the results from theanalog testing device. In some embodiments, the determination of thetest results, due to the type of analog testing device, is notdetermined locally by the application 3124. In some embodiments, theunique identifier may be transmitted to the server 3116, via the network3120, for remote analysis of the data contained in the uniqueidentifier. In some cases, results from the analog testing device may bedetermined locally and remotely. In some instances, the user of themobile device 3102 may not have cellular network or Internet connection,for instance, the settings for connectivity on the mobile device 3102 isdisabled, turned off or a combination thereof. In this case, thetransmission of the unique identifier to the server 3116 may bepostponed until a connection is available.

In some embodiments, the mobile device 3102 may include a locationsensor, such as a global positioning system (GPS) sensor or othercomponents by which geographic location is obtained, for instance, basedon the current wireless environment of the mobile device 3102, likeSSIDs of nearby wireless base stations, or identifiers of cellulartowers in range. In some cases, geographic locations are inferred by,for instance, an IP address through which a given mobile device 3102communicates via the Internet, which may be a less accurate measure thanGPS-determined locations. In other cases, geographic location isdetermined based on a cell tower to which a mobile device 3102 iswirelessly connected. Depending on how the geographic data is acquiredand subsequently processed, that data may have better or less reliablequality and accuracy.

FIG. 32 illustrates a diagrammatic view of an analog testing device to adigital format and unique identifier conversion process 3200 inaccordance with various embodiments of the present disclosure. A testingdevice 3202 may provide medical test results in an analog format, suchas in a results display window 3204 indicating a positive or negativesign, a color spectrum, a line, a circle, a curve, a balloon, asignature marker, or variance of the like. A biologic specimen may bedeposited into the testing device 3202 where the biologic may bind orreact with particular reagents specific to the type of test to which thetesting device 3202 pertains. The testing device 3202 may also include atest type identifier 3206, such as a code, graphic, symbol, or otherindicator on a surface of the testing device 3202.

A mobile device 3208, which may be the mobile device 3102 describedherein, may include a capture device 3210. The mobile device 3208 mayconvert use the capture device 3210, in addition to other data known orotherwise obtained by the mobile device 3208, to convert the analog dataand biologic presented by the testing device 3202 to a digital uniqueidentifier 212. When digital media such as an image, video, or otherdigital format of the testing device 3202 is captured by the capturedevice 3210, certain properties may be analyzed, processed, and storedinto as a digital data package. For instance, the test type associatedwith the testing device 3202 may be determined by the mobile device 3208by identifying the particular test associated with the test typeidentifier 3206 captured within the digital media.

Test results provided in the results display window 3204 or elsewhere onthe testing device 3202 may also be captured within the digital mediaand analyzed. For example, in the case of a color indicator as theresult of the test, the RGB values of the pixels contained in thedigital media of the test results may be determined in order to providea digital value for the test results. The test result may be stored inthe digital data package in a particular digital format, for instance, apositive or negative test result value. The value may be a binary value,a rating, a probability, or other type of result indicator. The biologicspecimen used to conduct the test may also be included in the digitaldata package. The biologic specimen provided into the testing device3202 may be determined from the test type identifier 3206, since in manycases the specific test will dictate the biologic to be used.

The data provided by the digital data package may also include the type,manufacture and serial number of the testing device 3202, and atimestamp for when the capture device 3210 captured the digital media.The manufacture, serial number and cellular provider of the mobiledevice 3208 may also be included in the digital data package. Theapplication 3124 may then generate the unique identifier 3212 from thedata of the testing device 3202 and mobile device 3208, in combinationwith data of the user of the mobile device 3208. Data of the user may bethe user's name, birthday, age, gender, social security number, height,weight, race, diagnosis status, insurance information, medical codes,drug codes, and the like, and a combination thereof.

In some embodiments, the unique identifier may be verified by averification server, such as the server 3116, to determine theauthentication of the biological specimen. In some cases, the user mayprovide the analog testing device 3202 with a substance not classifiedas a biological specimen. In this instance, an application on the server3116 will provide the application program 3124 with a message indicatingan error, in which the user may be required to provide a biologicalspecimen to a different analog testing device. In some embodiments,after verification of a biological specimen, the local applicationprogram 124 or the server 3116 via the user's application program 124will provide the user with a positive or negative outcome of the analogtesting device 3202. In some cases, the user is displayed a negativetest result and the application program 124 of the mobile device 3208indicates that testing is completed. In other cases, the user isdisplayed a positive test result by the application program 124 on thedisplay 3110 of the mobile device 3208.

The unique identifier 3212 may include of a plurality of digital datastreams 3214 used during creation of the unique identifier 3212, such asinformation included within the digital data package, or otherwise knownor obtained by the mobile device 3208 or the server 3116. The pluralityof digital data streams 3214 (D1, D2, D3, D4 . . . Dn) may be assembledtogether to create the unique identifier 3212, and the mobile device3208, the server 3116, or the authorized system components may parse ordeconstruct the unique identifier 3212 to analyze specific userproperties or test properties, and to trigger events based on theproperties.

Creating a single unique identifier 3212 which contains many differentitems of information is an efficient way of associating many differenttypes of information with a single biologic, user, test, etc. Every timea test is conducted, a new unique identifier 3212 may be created. Eachunique identifier created may include the plurality of data streams3214. Each one of the plurality of data streams 3214 in the uniqueidentifier 3212 stores a different type of information. In someembodiments, the information stored in data streams 3214 includes thetest type, the test results, demographics of the user, or anidentification number, such as an IMSI number, for the mobile device3208. Different embodiments may include different data streams 3214, asis described hereinbelow with respect to FIGS. 4A-4K. In someembodiments, the unique identifier 3212 is set up in a structuralformat, such that each data stream 3214 is a subcomponent of the uniqueidentifier 3212. In some embodiments, unique identifier 3212 is a stringof alphanumeric characters, and the data streams 3214 which make up theunique identifier 3212 are simply different portions of the characterstring. In these embodiments, the format of the unique identifier 3212is known to a database or server which can correctly parse the uniqueidentifier 3212 into the separate data streams 3214 for analysis.

FIG. 33 illustrates one example of a unique identifier 3212 inaccordance with various embodiments of the present disclosure. In thisexample, the plurality of data streams 3212 includes, but is not limitedto, test data, such as test type, biologic data, such as biologic typeor types used by the test, test results obtained upon completion of thetest, user data such as demographics, and mobile device data, such as anIMSI number.

Referring now to FIG. 34A, there is illustrated an embodiment in whichone of the data streams 3214 of the unique identifier 3212 is a testidentification, TID data stream 3402. The TID data stream 3402identifies the type of test which the user is conducting (pregnancy,HIV, peanut allergy, etc.). In the example depicted in FIG. 34A, the TIDdata stream 3402 is a character string of “F1A,” which indicates thatthe test is for the flu, is test version “1,” and is a test of anexample “A” type of flu substrain. Different embodiments of TID datastream 3402 will have different sizes of character strings, or will notbe character strings at all. In some embodiments, this information isobtained when a user uses the mobile application to scans a barcode orimage from the test product, or when the user inputs an identificationcode into the mobile application. In some embodiments, the data in theTID data stream 3402 is used by the mobile application to determinewhich database to access when processing the results of the medicaltest.

Referring now to FIG. 34B, there is illustrated an embodiment in whichone of the data streams 3214 of the unique identifier 3212 is a uniquedevice identification, or UDID data stream 3404. The UDID data stream3404 contains information which uniquely identifies the mobile device onwhich the application is running. Many devices, such as mobile phones,have unique identifiers built-in by the manufacturer, often in the formof long character strings, such as an IMSI number. In some embodiments,the UDID data stream 3404 is a character string which includes such anidentifier. In other embodiments, the UDID 3404 is generated by themobile application or the mobile application user.

Referring now to FIG. 34C, there is illustrated an embodiment whichincludes a SOID (self/other identification) data stream 3406. The SOIDdata stream 3406 is a data stream 3214 which designates whether themedical test is being performed on the mobile application user, orwhether the test is being performed on an individual other than theuser. The SOID data stream 3406 also identifies the relationship betweenthe person being tested and the mobile application user. Someembodiments also include basic demographic data, such as gender or agerange, in the SOID data stream 3406. For example, if the person beingtested is a small child, then the actual user of the mobile applicationmay be the child's mother or father. In the example depicted in FIG.34C, the SIOD data stream 3406 is a character string which reads “CF3,”which indicates that the person being tested is a child of the mobileapplication user, is female, and is three-years-old. Naturally, otherembodiments will have different formats for the SOID data stream 3406,and may not be character strings.

Referring now to FIG. 34D, there is illustrated an embodiment whichincludes a data stream 3408 which contains demographic information. ADEMZIP data stream 3408 (demographic/ZIP code) contains informationabout the person being tested with the medical test. In the exampleillustrated in FIG. 34D, the DEMZIP data stream 3408 includes acharacter string which represents the gender, age range, and geographiclocation (in the form of a ZIP code) of the person being tested. Forexample, in FIG. 34D, the DEMZIP data stream 3408 indicates that thetest subject is a male, in age range 4, who is located in the ZIP code78237. In other embodiments, the DEMZIP data stream 3408 will haveadditional demographic traits included, such as height or weight. Someembodiments will contain geographic location information in a formatother than ZIP code, such as city, state, or country names. In someembodiments, such as is illustrated in FIG. 34D, the DEMZIP data stream3408 will be a character string, while in other embodiments, it willtake other forms.

Referring now to FIG. 34E, there is illustrated an embodiment in whichthe unique identifier 3212 contains a data stream 3214 which indicateswhether or not the user has supplied their personal email address. Apersonal email data stream 3410 does not actually contain the emailaddress of the user, but it does indicate whether or not the user hassupplied an email address to the mobile application. In someembodiments, if personal email data stream 3410 indicates that the userhas supplied an email address, then when the unique identifier 3212 ispassed to a remote server, the remote server will link the uniqueidentifier 3212 with the email address of the user which has been storedin a separate database. In some embodiments, such as illustrated in FIG.34E, the personal email data stream 3410 is a simple character string of“Y” or “N” to indicate “yes” or “no” with regard to whether an email hasbeen supplied. Other embodiments will have a “1” or a “0” for “yes” or“no” or may have other character strings or data formats.

Referring now to FIG. 34F, there is illustrated an embodiment of a datastream 3214 for a unique identifier 3212 which contains a timestamp ofwhen a completed medical test is scanned or photographed by the mobileapplication. Knowing exactly when a medical test was scanned by a mobileapplication can be very important in different types of analysis. Inthis embodiment, the DTS data stream (date/time stamp) 3412 indicatesthe time in a YYMMDDHHMMSS format, that is, the first two charactersindicate the year, the next two indicate the month, the next twoindicate the day, the next two indicate the hour (in a 24-hour dayformat), the next two indicate the minute, and the last two indicate thesecond. Naturally, some embodiments will have other formats for the DTSdata stream other than a 12-character string, and will have differentlevels of specificity with regard to the time.

Referring now to FIG. 34G, there is illustrated a data stream 3214 foran embodiment in which a unique identifier 3212 contains informationrelated to the results of a medical test. These embodiments will havetest results, or information related to test results as part of theoverall unique identifier 3212 as an EVRK (Evaluation of Results andRanking of the Diagnosis) data stream 3414, as opposed to, or inaddition to, the results being in a totally separate file. Inembodiments of the system which use numerical values for test results,these values will be incorporated into the EVRK data stream 3414. Someembodiments will also include an escalation scale, which is a numericalindication, as a number on a predetermined scale, of how urgent orserious a potential medical problem might be. In the example illustratedin FIG. 34G, the EVRK data stream 3414 is a character string and has avalue of “0982,” with the first three digits representing the results ofthe test and the last digit representing the escalation scale value.Other embodiments will have other formats for the EVRK data stream 3414and will have the results indicated in other ways, such asalphanumerically, rather than just numerically.

Referring now to FIG. 34H, there is illustrated a data stream 3214 foran embodiment in which a unique identifier 3212 includes an indicationof whether or not the user wishes to have the test results sent to ahealthcare provider. In these embodiments, the unique identifier 3212includes a PDr (personal doctor) data stream 3416. The PDr data stream3416 is simply an indication of whether or not the user wishes to havethe test results transmitted to the user's healthcare provider. In someembodiments, a user inputs this preference into the mobile applicationafter completing the medical test, while in other embodiments, thispreference is input into the mobile application separately from anyparticular test. In some embodiments, an indication of wanting theresults sent to the healthcare provider will initiate a telemedicinesession with the healthcare provider. In some embodiments, such as thatwhich is illustrated in FIG. 34H, the PDr data stream 3416 is a short,simple character string, such as “Y,” “N,” “1,” or “0.” Otherembodiments will have different formats.

Referring now to FIG. 34I, there is illustrated a data stream 3214 foran embodiment in which a unique identifier 3212 includes informationidentifying the user's healthcare provider. In these embodiments, theunique identifier 3212 includes a Healthcare Provider data stream 3418.The Healthcare Provider data stream 3418 includes information which canbe used in a storage database to look up the healthcare providersidentification and contact information. This information would be usedin situations where the mobile application user indicates that they wishto have the medical test results sent to the healthcare provider. Insome embodiments, the Healthcare Provider data stream 3418 contains acode which is used to look up more detailed information from anotherstorage database, while in other embodiments, the identificationinformation and the contact email address or phone number is stored inthe data stream itself.

Referring now to FIG. 34J, there is illustrated a data stream 3214 foran embodiment in which a unique identifier 3212 includes informationrelating to a retail suggestion. For these embodiments, a RetailSuggestion data stream 3420 is included in the unique identifier 3212.The Retail Suggestion data stream 3420 includes data which identifies aretailer or a product or service which can be suggested (for example,through the mobile application) to a user. In some embodiments, thesesuggestions are based on the type of medical test performed. In otherembodiments, the suggestions are based on the results of the medicaltest. For example, if the medical test is a pregnancy test which returnsa positive result, then the suggestion might be for a brand of babydiapers. In the example illustrated in FIG. 34J, the Retail Suggestiondata stream 3420 provides a suggestion of Tylenol (“TYL”) which can bepurchased at Walgreens (“WAL”). In the example illustrated in FIG. 34J,the Retail Suggestion data stream 3420 is a character string. In otherembodiments, the format of the Retail Suggestion data stream 3420 willbe different. In some embodiments, the Retail Suggestion data stream isutilized in situations where the PDr data stream 3416 indicates that theuser does not wish to have the test results communicated to a healthcareprovider.

Referring now to FIG. 34K, there is illustrated a data stream 3214 foran embodiment in which a unique identifier 3212 includes informationidentifying the user's insurance I.D. In these embodiments, the uniqueidentifier 3212 includes an insurance I.D. data stream 3422. Theinsurance I.D. data stream 3422 includes information which can be usedin a storage database to look up a user's insurance information. Thisinformation would be used in situations where the mobile applicationuser indicates that they wish to have the medical test results sent tothe healthcare provider, pharmacy, or other entity to allow the user'sinsurance to be used for a transaction, such as filling a prescription.

Referring now to FIG. 35A, there is illustrated an embodiment of asystem in which a prescription is transmitted to a pharmacy using amedical test and telemedicine. In these embodiments, rather than thepatient needing to physically travel to a pharmacy to drop off aprescription to be filled, the user uses a mobile application toelectronically transmit the prescription information to the pharmacy.These embodiments improve upon embodiments which use medical tests andtelemedicine and take advantage of the fact that the user is alreadyengaged in a telemedicine session with the user's healthcare providerthrough a network 3502 such as the internet. In these embodiments, theuser engages in a telemedicine session with a healthcare provider asdescribed herein, via Path {circle around (1)}. When the user and thehealthcare provider complete the telemedicine session, the healthcareprovider can prescribe necessary medicine to the mobile applicationuser. However, since the user is not physically present with thehealthcare provider, the user does not pick up a physical prescriptionslip. Instead, the healthcare provider transmits via Path {circle around(2)} the prescription in electronic form either to the user's mobileapplication, or to the pharmacy of the user's choice. If the healthcareprovider transmits the “electronic prescription” to the user's mobileapplication, then the user can then store the electronic prescription onhis mobile device 3102 in the mobile application until he is ready toget the prescription filled. The user then uses the mobile applicationto send the electronic prescription to the pharmacy via Path {circlearound (3)}. The pharmacy then fills the prescription as normal.

Referring now to FIG. 35B, there is illustrated another embodiment of asystem in which a prescription is transmitted to a pharmacy using amedical test and telemedicine. These embodiments are similar to thosedescribed herein with respect to FIG. 35A. The system includes a userwith a mobile device 3102 running a mobile application, a healthcareprovider, a pharmacy, and a remote server or central office with arecords database. In these embodiments, the user participates in atelemedicine session with a healthcare provider via Path {circle around(1)} as described herein. Next, if the healthcare provider decides thata prescription is needed, the healthcare provider creates a prescriptionrecord and transmits the record through a network 3502 such as theinternet to a central office 3504 or remote server via Path {circlearound (2)}. The central office 3504 then stores the record in a recordsdatabase 3506. When the user is ready to have their prescription filled,they use the mobile application on the mobile device 3102 to contact thecentral office 3504 via Path {circle around (3)}. The central office3504 then retrieves the prescription record from the database 3506 andsends the prescription record to the pharmacy via Path {circle around(4)} to have the prescription filled. With this method, the healthcareprovider does not have to worry about which pharmacy to send theprescription to, and the fact that the prescription record does not haveto be stored on the mobile device 3102 means that the user couldpotentially access the prescription record from another mobile device orany other compatible device with network access.

Referring now to FIG. 36 , there is illustrated an embodiment of asystem which utilizes a remote diagnostic test to initiate a medicalescalation and intervention. In some situations, the result of a medicaldiagnostic test will indicate that immediate or urgent medical attentionis needed for the patient. In some embodiments, medical attention willbe summoned automatically in these situations. In these embodiments, theuser performs a medical medical test and uses a mobile applicationrunning on a mobile device 3102 to capture an image of the test product,as described herein. The mobile application then transmits, via Path{circle around (1)}, the test information through a network 3602 to aremote server or central office 3604. The central office 3604 accesses adatabase 3606 for the necessary information to generate a result for themedical test. The central office 3604 may also retrieve from thedatabase 3606 criteria for determining whether or not a medicalescalation or intervention is warranted on the basis of the testresults. The central office 3604 generates a test result and checks thecriteria to determine if medical escalation is needed. If no medicalescalation is needed, the central office 3604 simply returns, via Path{circle around (2)}, the test results to the mobile device 3102 throughthe network 3602. If, however, the central office 3604 determines thatsome type of medical escalation is warranted, then the central officetransmits, though the network 3602 via Path {circle around (3)}, thetest and test result information, along with information about the user(such as any relevant personal, demographic and/or contact informationcollected from the user) to a healthcare provider 3608. Alternatively,instead of the healthcare provider 3608 being contacted by the centraloffice 3604, in some embodiments, the fact that a medical escalation isneeded is transmitted along with the test results from the centraloffice 3604 through the network 3602 via Path {circle around (2)} to themobile device 3102 running the mobile application. The mobile device3102 then transmits the test and test result information to a healthcareprovider 3608 through the network 3602 via Path {circle around (4)}.

The manner of the medical escalation or intervention varies depending onthe embodiment, and may vary depending on the type of test and/or thetest results. In some embodiments, the escalation takes the form ofnotifying emergency medical personnel, rather than a healthcare provider3608, of an urgent medical situation. In these embodiments, the centraloffice may call 911 or in some other way notify emergency services Theseembodiments would be useful, for example, if a blood test shows that themedical test user has near fatal levels blood sugar or that the user ishaving a heart attack or stroke. In other embodiments, the medicalescalation takes the form of the mobile application on the mobile deviceautomatically initiating a telemedicine session with a healthcareprovider 3608. These embodiments are useful, for example, in urgent, butnot quite emergency, situations. For example, elevated blood sugar orhigh blood pressure might not be immanently deadly to a patient, butshould still be addressed and brought to the attention of a healthcareprovider 3608 quickly. In other embodiments which are most useful forurgent—but not quite emergency—situations, the central office 3604notifies the healthcare provider 3608 of the test results, and leaves itup to the healthcare provider to determine the best next course ofaction to take with respect to the patient.

Referring now to FIG. 37 , there is illustrated an example of a tablewhich would be found in the database of a central office 3604 and whichcontains criteria for when to initiate a medical intervention based onthe results of a remote diagnostic test. The table 3702 includes severalcolumns of information. In the example embodiment depicted in FIG. 37 ,the diagnostic test is a quantitative one which produces a numericalrating as part of the test result, similar to the embodiments describedherein. An example of such a test could be a blood glucose test, whereina certain risk is generally associated with a range of glucose levels.In this example, a low test result “rating” indicates a low health riskfor the condition being tested, while a higher “rating” indicates ahigher risk. In the some embodiments which use a table such as table3702, different types of medical intervention are used for differenttest results. The first column 3704 of table 3702 specifies a range oftest result “ratings,” while the rest of the columns 3704, 3706, and3708 specify information correlating to that rating range. Column 3706specifies the health risk associated with a particular test resultrating from column 3704, and column 3708 specifies what type of medicalintervention will be initiated for a test result within a given range.For example, if a user conducts the example medical test, and thecentral office 3604 generates a test result rating of 57 (whichindicates a dangerous health risk), then the central office will notonly return the test result to the user, it will also initiate an urgentmedical intervention, such as initiating a telemedicine session betweenthe user and a healthcare provider. If the central office 3604 generatesa test result rating of 93 (which would indicate a deadly health risk),then the central office will initiate an emergency health intervention,such as notifying emergency medical services of the user's condition. Onthe other hand, if the test result rating is in the “NORMAL” or“ELEVATED” range, then no medical intervention will be initiated, andthe central office 3604 will simply return the test results to the userand the mobile device 3102. Naturally, other embodiments will havedifferent styles of tables in the central office 3604 database. Someembodiments which have qualitative rather than quantitative tests (forexample, testing simply “positive” or “negative” for a disease) will nothave various multiple different types of medical intervention.

Referring next to FIG. 38 , there is illustrated an embodiment whichincludes mapping a diagnostic test to an individual user to create aunique profile on a remote database. Each time a patient conducts amedical test, there is a change to gather information about that patientand the patient's test. Instead of each piece of information about apatient or a test being regarded individually, multiple data points andpieces of information for a common patient can be associated with eachother, providing a greater insight into and creating a detailed profileof the patient. Referring to FIG. 38 , there is illustrated a uniqueprofile record 3800. Each unique profile record 3800 is associated withan individual patient or diagnostic test user and has a unique ID 3802.The unique profile record 3800 contains information associated with thepatient/user, such as the patient name 3804, the name of a healthcareprovider 3806 associated with the patient, or the name of a pharmacy3808 associated with the patient. Importantly, the unique profile record3800 also includes the biologic IDs 3810 associated with the user. Eachbiologic ID 3810 is the same ID as the biologic header 3902 in one ofthe unique biologic ID database tables 3900. Thus, the unique profilerecord 3800 includes a “link” to the record of each biologic used by thepatient associated with the unique profile record. Each time adiagnostic test is conducted on a biologic sample, the biologic sampleis associated with the unique profile record 3800, which means theunique biologic ID database table 3900 (which includes data about thetest) is associated with the unique profile record 3800 and the user.This means that more information about the patient is collected andaccumulated.

Different embodiments will include different types of data to be storedwithin each unique profile record 3800. In some embodiments, the uniqueprofile record 3800 includes information about food or medications towhich the patient is allergic. Some embodiments of the unique profilerecord 3800 include records of which illnesses which the patient hashad. Virtually any type of information related to the patient/user canbe included in the unique profile record 3800 in various embodiments, solong as it contributes to construction a better “picture” of thepatient/user.

Referring now to FIG. 39 , there is illustrated an example of a uniquebiologic ID database table 3900. The table 3900 is illustrative of thetype of data stored in association with data for a biologic transmittedby a mobile device 3102 for storage on the database 3118. A biologic IDheader 3902 is provided that shows that the biologic sample has beengiven a unique ID. All data concerning the biologic may be stored inassociation with the unique biologic ID. The table 3900 also includes abiologic type entry 3904. This designates what type of biologic that thebiologic associated with the unique ID is, such as blood, urine, stool,saliva, sweat, or other biologics. The table 3900 also provides aplurality of test ratings 3906, for various tests performed on thebiologic. In the example shown in FIG. 39 , a blood biologic is providedhaving an assigned ID of 2402, and having been testing for pregnancymarkers, the Zika virus, and for glucose levels. The rating forpregnancy was a 99 rating, the rating for a Zika infection was a 75, andthe rating for glucose levels was a 10. This would indicate that thetest subject has an extremely high likelihood of both a pregnancy and aZika infection, which would have resulted in a warning to seek medicalattention at the conclusion of the tests. Other information may also bestored in the database in relation to the biologic, including othercondition ratings, time and date each test was performed, userinformation such as ethnicity, gender, and age, and status indicatorssuch as whether a test subject visited a physician as a result of thetests. The database 3118 thus provides the test subject with a growingcollection of information that may be accessed by the test subject. Thisallows the test subject to present the test results to her physician formedical attention or additional testing, and allows for others who mayaccess the database, such as disease researchers, to have access to dataon various biologic samples and their markers.

Referring next to FIG. 40 , there is illustrated an embodiment whichincludes mapping diagnostic tests to individual users to create uniqueprofiles. The patient/user 4001 conducts a medical test using a mobiledevice 3102. The first time the patient 4001 uses the mobile applicationon the mobile device 3102, the application allows the patient to createa unique ID 3802 to be assigned to the unique profile record 3800associated with the patient. In some embodiments, the unique ID 3802 issimply assigned by the mobile application instead of being chosen by theuser 4001. After a test is conducted, the mobile application transmitsthe biologic ID 3902 of the biologic tested along with the unique ID3802 along Path CI through a network 4002, such as the internet, to aremote server or central office 4004. Once the biologic ID 3902 and theassociated unique ID 3802 reaches the central office server 4004, thecentral office server transmits the biologic ID and the unique ID to aconnected database 4006. Within database 4006 are stored the uniqueprofile records 3800 for each patient/user 4001. Once the database 4006receives the biologic ID 3902 and the unique ID 3802, the database usesthe unique ID to identify the correct unique profile record 3800 andthen appends the biologic ID 3902 to that unique profile record. If thisis the first test conducted for/by a particular patient/user 4001, thenthe database 4006 creates a new unique profile record 3800 with theprovided unique ID 3802 and appends the biologic ID 3902. In this way,each time a user 4001 conducts a diagnostic test, the unique ID 3802 andthe biologic ID 3902 are sent to the database 4006, where the uniqueprofile record is incrementally augmented with additional informationabout the user/patient 4001. In some embodiments, the biologic ID 3902is not assigned by the application on the mobile device 3102. Instead,the mobile device sends the information relating to the biologic (testtype, test results, etc.) to the central office server 4004 and database4006, which then assign a biologic ID 3902 to the biologic data andassociate it with the appropriate unique ID 3802.

Data for other users 4001 with other unique profiles 3802 will behandled similarly. Since each user 4001 has a unique profile record 3800associated with him or her, the database 4006 will be able to associatedbiologic IDs 3902 with the correct user. In this way, the database 4006will be populated with unique profile records 3800, from whichpotentially vast amounts of data can be obtained.

Referring now to FIG. 41 , there is illustrated a flowchart for anembodiment which includes mapping a diagnostic test to an individualuser to create a unique profile on a remote database. The process startsat Start block 4102 and proceeds to function block 4104, where the userlaunches the mobile application on the mobile device 3102. The processthen moves to decision block 4106. If a unique ID 3802 for the user doesnot exist, the process moves to function block 4108, where a unique IDis created by the mobile application. The process then moves to functionblock 4110. If, at block 4106, a unique ID 3802 for the user does exist,the process skips block 4108 and moves to function block 4110. At block4110, the user conducts a diagnostic test with a testing device 3130 anda mobile device 3102 as described herein. The process then moves toblock 4112, where the mobile application transmits the biologic IDinformation 3902 (which will also link the user to data about the typeof diagnostic test) and the unique ID 3802 to the remote server 4004. Atstep 4114, an ID is assigned to the biologic information. The processthen moves to decision block 4118. If a unique profile record 3800 forthe user does not exist, the process moves to function block 4116, wherea unique profile record is created. The process then moves to functionblock 4120. If, at decision block 4118, a unique profile record 3800 forthe user already exists, the process moves to block 4120. At block 4120,the database 4006 appends the biologic ID information 3902 to the uniqueprofile record 3800. The diagnostic test performed by the user is nowmapped to the user's profile 3800 through the biologic database ID table3900. The process then ends at End block 4122.

In some embodiments, a medical test may be performed by a doctor, labtechnician, etc. and may use an automated testing device to perform thetest. In this scenario, the test may be used to determine a treatmentregimen for a patient based on the test results. For instance, if thetest is designed to determine the proper medication and dosage level ofthat medication to effectively treat a patient, this information may beadded to a patient file and transmitted to other parties to alert theother parties to take action in order to enact the treatment plan.

FIG. 42 illustrates a diagrammatic view of a medical test results,trends, and response system 4200. The system 4200 includes a centralizedsystem 4202. The centralized system 4202 may include or be connected toan actionable analytics database 4204, a trends engine 4206, and aplurality of patient records 4208. The plurality of patient records 4208may include patient demographics and personal information, medicalhistory including test results, doctor's notes, etc., medicalinformation specific to the patient such as DNA data, blood type,markers detected during tests on the patient, or other types ofinformation. The centralized system 4202 may act as a central hub ofinformation for various entities related to the medical industry. Thesevarious entities may be interconnected with each other as well as withthe centralized system 4202.

For example, the system 4200 illustrated in FIG. 42 further includes oneor more of the following: a doctor's office 4210, a test site 4212, auniversity of higher learning 4214, a research database 4216, a researchlab 4218, a hospital 4220, a compounding pharmacy 4222, a retailpharmacy 4224, the centralized system 4202, and other entities 4226. Allthese entities may be interconnected over a network 4228 to shareinformation and otherwise provide an infrastructure for tracking medicaltest results, disease trends, pharmaceutical effectiveness trends,triggering medical actions for patients, etc. For example, test resultsgenerated by using the microfluidic chip described herein may includedrug efficacy and proper dosage information pertaining to a patient.This information may be passed from the entity in the system 4200 thatperformed the test, such as a doctor's office 4210, a hospital 4220, aresearch lab 4218, or any other test site 4212 or other entity 4226. Theresults may then be received by the centralized system 4202 to update apatient record 4208 stored in associated with the centralized system4202. The test results, test information, patient information, and otherdata may be stored in the database 4204 or processed by the trendsengine 4206 to evaluate overall patient health, and to determine whetherthe patient is susceptible to other medical conditions or whether thetest results received regarding the patient are indicative of trends orother medical conditions concerning other patients whose information isstored in the centralized system 4202. The results may also be utilizedin advancing medical research, such as by universities 4214, researchlabs 4218, and by updating research databases 4216.

Referring now to FIG. 43 , and still to FIG. 42 , patient records onfile with any of the entities 4210-4226 may also be updated to reflectthe new information obtained as a result of the test. FIG. 43illustrates the types of information that may be recorded in a patientrecord 4208, or in the database 4204, in accordance with variousembodiments of the present disclosure. FIG. 43 shows that a patient mayhave a patient record 4302. This patient record may be stored as adocument on the centralized system 4202, such as a text file, PDF file,excel file, or other document, or the data in the patient record 4302may be stored in the database 4204. Particular test types may have IDnumbers associated with the particular test types. The ID for the testtype may be stored in relation to a patient record when the testassociated with the test ID is performed on the patient associated withthe patient record. Results of the test performed on the patient or on apatient's biologic specimen may also be stored in relation to thepatient.

For example, FIG. 43 shows that test results 4304 of a test having atest ID of 10 are stored in relation to a patient having a patient ID of1002. Test information results, treatment plans, and other informationmay be stored in relation to the patient. For example, and asillustrated in FIG. 43 , if a patient is found to be positive for abacterial infection, such as streptococcal bacteria, and results from atest conducted using the microfluidic chip described herein indicatethat the most effective medication and dosage to treat the infection isamoxicillin at 250 mg, this information may be transmitted across thesystem 4200. The centralized system 4202 may receive the test resultsand generate a treatment plan or regimen that indicates that the patientshould take amoxicillin at 250 mg twice daily for two weeks. Thetreatment regimen may be generated for the patient and this treatmentregimen may be transmitted to entities responsible for enacting thetreatment regimen, such as the doctor's office 4210, the compoundingpharmacy 4222 or the retail pharmacy 4224, etc.

Referring now to FIG. 44 , there is illustrated a flowchart of a patientrecord update/creation process 4400. The process begins at step 4402when a medical test is performed to determine a treatment plan for apatient, such as a test using the microfluidic chip described herein. Atdecision block 4404, an entity such as the centralized system 4202determines whether the patient is a new patient, which may be done byquerying the database 4204 for personal information relating to thepatient to determine if that information already exists in the databasesuch as a social security number. If it is determined that the patientis a new patient, the process flows to step 4406 to generate a newrecord for the patient. The process then flows to step 4410. If atdecision block 4404 it is determined that the patient already has apatient record stored, the process flows to step 4408 where the existingpatient record is updated with the results of the test performed in step4402. The process then flows to step 4410. At step 4410, a treatmentregimen is determined for the patient based on the test results data.For instance, if a particular medication at a particular dosage levelwas tested as effective against a medical condition of the patient, aregimen of administration of the medication may be generated.

The process then flows to step 4412 to save the treatment regimen to thepatient record. At step 4414, an overall patient health report may besaved to the patient record. This health report may include generalinformation relating to the patient from other office visits, such asweight, medical states such as diabetes or other states, and may includethe medical condition with respect to the test conducted in step 4402,such as stating the test date, severity of the condition, detailsregarding the treatment regimen and drug interactions and side effects,etc. The process then flows to step 4416. At step 4416, the treatmentregimen, overall health report, and other patient information may betransmitted to entities that may use such information to treat thepatient, such as a doctor's office, hospital, or other entity.

Referring now to FIG. 45 , there is illustrated a sequence diagram of atest results and treatment regimen enactment process 4500. At step 4502,a doctor sends a request to a test site to schedule a test. The testsite at step 4504 then performs the scheduled test. At step 4506, atreatment plan is generated at the test site. The test site may generatethe treatment plan when generation of the treatment plan is automated bythe device performing the test, or by a professional analyzing the test.In some embodiments, the test results may be sent elsewhere fordetermining the treatment plan, such as to the doctor or to thecentralized system.

At step 4508, the test site sends an update to the patient record at thecentralized system with test results and a treatment plan. At step 4510,the centralized system transmits the test results and treatment plan tothe doctor's office. At step 4512, the doctor's office confirms thetreatment plan with the patient and at step 4514 the doctor's officesends a confirmation of the treatment plan and any written prescriptionsto the centralized system. At step 4516, the centralized system updatesthe overall patient profile and database associations to that patientprofile. For example, if the patient is a Caucasian female, and the testresults were positive for Crohn's disease, such an association may bemade in the database as a potential trend or susceptibility, but maywait for additional data before marking it as an active trend.

At step 4518, the centralized system requests one or more prescriptionsfrom a pharmacy according to the treatment plan. At step 4520, thepharmacy transmits a confirmation to the centralized system that theprescriptions were delivered to or pickup by the patient. At step 4522,a research database may request updated data from the centralizedsystem. The research database may utilize the centralized system as astorehouse for a multitude of information and data points related todiseases, patient demographics, biological markers, or other informationuseful to medical research and academia. At step 4524, the centralizedsystem transmits the requested data to the research database.

Referring now to FIG. 46 , there is illustrated a diagrammatic view of atrends engine 4602 in accordance with various embodiments of the presentdisclosure. The trends engine 4602 may be a linear or non-linear deeplearning neural network or trained database. Neural networks arenon-parametric methods used for machine learning such as patternrecognition and optimization. They are able to generate an output basedon a weighted sum of inputs, which is then passed through an activationfunction. Typically, the activation function determines the output bysumming the inputs multiplied by the weights. A basic activationfunction is that of y=f(Σwx), where x is the vector of inputs, w is thevector of weights, f(·) is the activation function, and y is the outputvector.

The inputs, weights, and outputs may be organized within a multilayerperceptron (MLP), wherein there is an input layer, one or more hiddenlayers, and an output layer. As shown in FIG. 46 , a plurality of inputsmay be entered into the trends engine 4602. The trends engine 4602 mayinclude a series of weighted neurons that pass the inouts through anactivation function t generate one or more outputs, or trends. Thetrends engine 4602 may be a feedforward network network. Although therecould be any number of hidden layers, typically ranging from one tothree, it will be appreciated by those skilled in the art that a singlehidden layer can estimate differentiable functions, provided there areenough hidden units. A higher number of hidden layers also increasesprocessing time and the amount of adjustments needed during neuralnetwork training.

It will be understood by those skilled in the art that the neuralnetwork would be trained in order for the neural network to become moreaccurate. Various training methods exist, such as supervised learningwhere random weights are fed into the neural network and adjustedaccordingly, backpropagation methods, or other methods. Activationfunctions are applied to the weighted sum of the inputs to generate acertain outcome. The weights may be set to small random valuesinitially. The input pattern may then be applied and propagated throughthe network until a certain output is generated for the hidden layer.Training results may be collected including the number of truepositives, true negatives, false positives, and false negatives. If thenumber or percentage of false positives and negatives appear too high,additional training may be required.

The outputs of the hidden layer are used as entries for the outputlayer. Weighted and summed up, they are passed through an activationfunction to produce the final output. The way the weights are modifiedto meet the desired results defines the training algorithm and isessentially an optimization problem. When the activation functions aredifferentiable, the error backpropagation algorithm may be a goodapproach in progressing towards the minimum of the error function. Theerrors are then passed back through the network using the gradient, bycalculating the contribution of each hidden node and deriving theadjustments needed to generate an output that is closer to the targetvalue. It will be understood by those skilled in the art that neuralnetworks can be set up and trained in various ways and that the abovedescription is illustrative of but one method. It will be appreciatedthat the neural network may be organized in any way to allow for thefunctionality disclosed herein.

In some embodiments, the trends engine 4602 may function on a thresholdsystem. For instance, if a certain number or percentage of patients thatare within a specific haplogroup also test positive for a specificmedical condition, this may indicate a trend output by the trends engine4602. As more positive results are received for a particular medicalcondition, the trends engine 4602 may query the database 4204 todetermine if there are any demographical or other commonalities betweenpatients that have tested positive for the medical condition. Forexample, if the threshold is set to 75%, and 80% of patients of Africandescent have tested positive for a medical condition, the trend engine4602 may communicate the trend to other entities within the system 4200,or provide the trend when the centralized system 4202 is accessed byother entities in the system 4200.

Referring now to FIG. 47 , there is illustrated one embodiment ofdatabase tables showing a particular trend. There is shown a patientrecord 4702. The patient record 4702 includes various data concerningthe patient, such as the test IDs for tests performed on the patient ora specimen from the patient. If a patient has a DNA test performed, apatient's haplogroup may be determined. Haplogroups may be Y-chromosomalor may be mitochondrial haplogroups. The centralized system 4202 maykeep track of a patients' haplogroups to attempt to find trends amongpatients that share a common ancestry. For example, FIG. 47 illustratesthat patient ID #1002, in record 4702, is within haplogroup C. Thus, thecentralized system 4202 may link the patient to data accumulated andtest results obtained regarding all patients that are within haplogroupC. Table 4704 illustrates that the centralized system 4202 may count thenumber of positive results for each test performed on a person ofhaplogroup C. In this example, patient ID #1002 has may have testedpositive for test ID 10. The table 4704 shows that a large number ofpeople in haplogroup C have also tested positive for test ID #10. Thereis also shown in patient record 4702 that the patient is susceptible toprostate cancer. This may be determined from a trend similar to thatshown in 4704. For instance, if test ID #10 tested for prostate cancermarkers, and the 10,720 positive results illustrated in FIG. 47 wasabove a threshold amount to activate a trend, all patients in haplogroupC, such as patient ID #1002, would have an entry added to his or herpatient record noting a trending susceptibility to prostate cancer.

Referring now to FIG. 48 , there is illustrated a sequence diagram of aresearch and trends feedback process 4800. At step 4802, a test site4212 performs a medical test, such as a test using the microfluidic chipdisclosed herein. At step 4804, the test site 4212 sends to thecentralized system 4202 a patient record update including test resultsand a treatment plan. At step 4806, the centralized system 4202 checkstrends via the trend engine 4206 and database 4204. At step 4808, thecentralized system 4202 requests current research regarding the medicalcondition of the patient from a research database 4216. At step 4810,the requested research is transmitted from the research database 4216 tothe centralized system 4202. At step 4812, the centralized system 4202transmits the test results, any trends regarding the patient or otherssimilar to the patient, the requested current research, and anyrecommendations based on this data to the doctor's office 4210. At step4814, the doctor's office 4210 requests additional testing for thepatient. The doctor may request additional testing because of trendsregarding the patient's condition or research that was provided to thedoctor in step 4812. At step 4816, the test site performs the additionaltesting.

At step 4818, the test site sends an update to the patient recordincluding the test results for the additional testing and a new orupdated treatment plan for the patient based on the additional testing.At step 4820, the test results are update patient record and treatmentplan are transmitted from the centralized system 4202 to the doctor'soffice 4210. At step 4822, the doctor's office 4210 sends confirmationof the updated treatment plan to the centralized office 4822.

Referring now to FIG. 49 , there is illustrated a medical conditiontrend activation process 4900. The process 4900 begins at step 4902,where patient information and the efficacy and dosage for particularmedications pertaining to a first patient produced by a first test areobtained by an entity such as the centralized server. At step 4904,patient information and the efficacy and dosage for particularmedications pertaining to a second patient produced by a second test areobtained by an entity such as the centralized server. At step 4906, theserver compares patient information of the second patient with thepatient information of the first patient. At decision block 4908, it isdetermined whether there is any significant patient information matches.For example, if the tests conducted on both patients were for Crohn'sdisease, and both patients are of the same gender and ethnicity, thenthere may be a significant patient information match. If there is nosignificant patient information match the process flows to end block4910. If there is a match, the process flows to step 4912 to store thepotential trend.

A trend may be stored as a potential trend when there is a correlatingdata point, but not enough data to activate it as an active trend in thesystem. At step 4914, the system receives a plurality of additional testresults from a plurality of addition conducted tests. The process thenflows to decision block 4916 to determine whether additional instancesof the potential trend stored in step 4912 is in an amount above athreshold. Such a threshold may be a certain number, a percentage of allpatients related to the trend demographic or other data point (such asall female patients of a particular ethnicity), or other thresholdtypes. If instance of the potential trend is not above the threshold,the process flows back to step 4914 to receive more test results. If atdecision block 4916 it is determined that the instances of the potentialtrend is above the threshold, the process flows to step 4918. At step4918, the system changes the status of the potential trend to an activetrend.

Referring to FIG. 50 , one embodiment of a system device 5000 isillustrated. The system device 5000 is one possible example of a deviceused by an end user, and/or a device such as the mobile device or theserver 4202. Embodiments include cellular telephones (including smartphones), personal digital assistants (PDAs), netbooks, tablets, laptops,desktops, workstations, telepresence consoles, and any other computingdevice that can communicate with another computing device using awireless and/or wireline communication link. Such communications may bedirect (e.g., via a peer-to-peer network, an ad hoc network, or using adirect connection), indirect, such as through a server or other proxy(e.g., in a client-server model), or may use a combination of direct andindirect communications. It is understood that the device may beimplemented in many different ways and by many different types ofsystems, and may be customized as needed to operate within a particularenvironment.

The system 5000 may include a controller (e.g., a central processingunit (“CPU”)) 5002, a memory unit 5004, an input/output (“I/O”) device5006, and a network interface 5008. The components 5002, 5004, 5006, and5008 are interconnected by a transport system (e.g., a bus) 5010. Apower supply (PS) 5012 may provide power to components of the computersystem 5000, such as the CPU 5002 and memory unit 5004, via a powersystem 5014 (which is illustrated with the transport system 5010 but maybe different). It is understood that the system 5000 may be differentlyconfigured and that each of the listed components may actually representseveral different components. For example, the CPU 5002 may actuallyrepresent a multi-processor or a distributed processing system; thememory unit 5004 may include different levels of cache memory, mainmemory, hard disks, and remote storage locations; the I/O device 5006may include monitors, keyboards, and the like; and the network interface5008 may include one or more network cards providing one or more wiredand/or wireless connections to a network 5016. Therefore, a wide rangeof flexibility is anticipated in the configuration of the computersystem 5000.

The system 5000 may use any operating system (or multiple operatingsystems), including various versions of operating systems provided byMicrosoft (such as WINDOWS), Apple (such as Mac OS X), UNIX, and LINUX,and may include operating systems specifically developed for handhelddevices, personal computers, servers, and embedded devices depending onthe use of the system 5000. The operating system, as well as otherinstructions, may be stored in the memory unit 5004 and executed by theprocessor 5002. For example, the memory unit 5004 may includeinstructions for performing some or all of the methods described herein.

Referring now to FIG. 51 , there is illustrated a block diagram of amobile point-of-care system 5100 in accordance with embodiments of thepresent disclosure. The mobile point-of-care system 5100 includes acentral server 5102 configured to communicate with a patient mobiledevice 5104 over a network 5106. The system 5100 allows for a user touse the patient mobile device 5104 to request point-of-care servicesfrom the central server 5102 at the location of the patient mobiledevice 5104. Upon receipt of such a request, the central server 5102communicates the request to one or more mobile point-of-care (POC) units5108 that are in communication with the central server 5102 over thenetwork 5106. One of the one or more mobile POC units 5108 can acceptthe request and travel to the patient mobile unit 5104 to providemedical POC services such as medical diagnostic testing, therapeutictreatments, prescription services, veterinary testing and treatments, orother services.

In some embodiments, the patient mobile unit 5104 may request a specificmobile POC unit 5108. For example, the patient mobile unit 510 caninclude an application used to facilitate POC service requests, and theapplication may be configured to display a map that shows the locationof available mobile POC units 5108. The user of the patient mobile unit5104 could then select a specific mobile POC unit 5108, such as if thespecific mobile POC unit 5108 is closest to the user, or if the userrecognizes the identity of the mobile POC unit 5108 and wishes torequest the POC services from that specific mobile POC unit 5108. Inother embodiments, the patient mobile unit 5104 may simply transmit arequest for POC services, and the first mobile POC unit 5108 to acceptthe request fulfills the POC service request. In other embodiments, thecentral server 5102 can assign the POC service request to one of themobile POC units 5108, for example based on proximity to the patientmobile unit 5104, or other factors. The user of the patient mobile unit5104 can request services to be performed on the user, or in someembodiments may request services for others, such as the user's spouse,children, or pets.

Referring now to FIG. 52 , there is illustrated an example mobileapplication POC request interface 5200. The interface 5200 is displayedto the user using the patient mobile device 5104 to request POCservices. The interface 5200 includes a “My Account” button 5202configured to direct the user to an interface to display the user'saccount information and the ability to edit the user's accountinformation, such as login information (username and password,biometrics, etc.), contact information such as a physical address, phonenumber, etc., and other information. The user's account can also includeinformation on medical status/history and other information, such asthat provided by the centralized system 4202, in accordance with thisdisclosure. The interface 5200 also includes a “New Request” button 5204to direct the user to an interface to request POC services, a “Map”button 5206 to direct the user to a display of a map showing availablemobile POC units 5108, and a “Request Status” button 5208 to display thestatus of a current request accepted by one of the mobile POC units5108.

The view illustrated in the interface 5200 in FIG. 52 , shows a portionof a POC service request interface 5210 for requesting a diagnostictest. The interface 5210 may be displayed in response to the userselecting the “New Request” button 5204. The interface 5210 includes apatient type selection area 5212 that allows the user to select the typeof patient to receive the POC services, such as a person or pet.Selection of one of the choices allows the user to view a sub-menu thatshows filtered selections based on the choice. For instance, if the userselects “person” as the patient type, the user can be provided asub-menu that allows the user to select the user, a spouse, a child, orothers allowed by the system as the recipient of the POC services.Likewise, if the user selects “pet” as the patient type, the user can bepresented with a sub-menu to select a pet type (dog, cat, bird, etc.)and additional sub-menus may be provided to select other parameters suchas breed, age, gender, etc. In some embodiments, the application mayhave stored thereon, or may retrieve from the central server 5102,information pertaining to the user's pet such as all data related to thetype of pet and past medical history or other medical informationgathered as a result of past medical services provided to the pet andstored on the system.

The interface 5200 also includes an illness/symptoms area 5216 thatallows the user to select the specific illness/condition or symptomsexperienced by the user or another person or pet. The illness/symptomarea 5216 may also include filtered sub-menus to provide more detailedinformation. For example, a pain selection in the illness/symptoms area5216 has a sub-menu for selecting the type of pain (such as area of thebody and sensation (burning, numb, shooting pain, etc.)) and may alsoprovide a selection for rating the severity of the pain. In someembodiments, depending on the choices selected, the application on thepatient mobile device 5104 may alert emergency services, or offer suchto the user, if the selections indicate a severe condition that requiresimmediate medical attention rather than a diagnostic test.

Referring now to FIG. 53 , there is illustrated a flowchart of oneembodiment of a POC service request process 5300. The process 5300begins at step 5302 when a user launches the POC service requestapplication on the user's mobile device 5104. At step 5304, the userenters user information, which may include identifying the person oranimal who will be receiving the POC services, symptoms experienced bythat person or animal, login/authentication information, and otherinformation. The application then allows the user to view availablemobile POC units 5108 at step 5306. The available mobile POC units maybe displayed to the user in a list, as icons at locations on a map, orin other ways. The mobile POC units displayed may be constrained orfiltered, either manually by the user or automatically by theapplication, based on parameters such as geographical proximity to theuser and the user's mobile device.

At step 5308, the user requests a mobile unit. A specific mobile unitmay be requested by the user, or a mobile unit may be assigned to theuser in response to requesting a mobile unit. At decision block 5310,the user is asked to confirm the request of the mobile unit. If the userdoes not confirm, the process 5300 ends at end block 5312. If the userconfirms the request, the process 5300 flows to step 5314. At step 5314,the travel progress of the mobile unit is displayed on the map displayedby the application on the user's mobile device. At decision block 5316,it is determined whether the mobile POC unit has arrived at the locationof the user's mobile device. If not, the process 5300 loops back to step5314. If so, the process flows to step 5318.

At step 5318, the user, or someone else the user requested the servicesfor, such as a family member or pet, is provided a service process froma medical technician or other person qualified to administer tests,write prescriptions, or provide medical treatments and who also operatedthe mobile unit requested at step 5308. At decision block 5320, it isdetermined whether the POC services offered by the mobile unit arecomplete. If not, the process flows back to step 5318. If so, theprocess ends at end block 5322.

Referring now to FIG. 54 , there is illustrated a flowchart of oneembodiment of the service process of step 5318. The process begins atstep 5402 where a patient interfaces with a medical testing device. Themedical testing device may be a medical testing device such as themicrofluidic devices described herein, such as the RT lamp device. Atdecision block 5404, it is determined whether a result has been providedby the testing device, whether it is positive or negative. If a resultis not yet provided by the testing device, the process loops back tostep 5402. If a result is provided, the process flows to decision block5406. At decision block 5406, it is determined whether a diagnosis isprovided. The diagnosis may be provided based on the results of themedical testing device, and may be provided by the medical provider thatadministered the test, or may be provided by a system that received theresults of the test and generated a diagnosis from the test results,such as the centralized system 4202 described herein.

If a diagnosis is not yet provided, the process loops at decision block5406 until the diagnosis is provided to the user. Once a diagnosis isprovided to the user, the process flows to decision block 5408. Atdecision block 5408, it is determined whether a therapeutic regimen issuggested for the user. The therapeutic regimen may be provided by thehealthcare provider administering the test, or may be provided by acentralized system based on the results of the test, medical data storedconcerning the user, and current trends for treating the medicalcondition and symptoms. If a therapeutic regimen is not suggested, theprocess ends at end block 5410. If a therapeutic regimen is suggested,the process flows to decision block 5412.

At decision block 5412, the system or the healthcare provideradministering the POC services determines if the therapeutic regimen canbe performed, or at least started, on site. This can be facilitated viathe healthcare provider or technician interpreting the results of thetest or by sending the test results in association with a user ID forthe patient to the central server, as described hereinabove. If sent tothe central server, at least the results can be analyzed by an expertsystem and recommendations made to the healthcare provider/technician,who can then complete the process via possibly canned questions so as tofill out an appropriate form to support any diagnosis. Once adetermination as to the regimen to be followed is determined from all ofthe available information, the healthcare provider administering the POCservices performs the therapeutic regimen. This can include providing aprescription or over the counter medication to the user, providingspecific treatment, whether the specific treatment is curative or simplymeant to ease the severity of symptoms, or other services. All of thisrequires the steps described hereinabove with respect to thetelemedicine process, with the exception that the test is not a selftest and the healthcare provider is on site and does not need to becontacted by remote connection. However, it may be that some remoteconnection is required if additional consultation is required as aresult of the test results requiring such. The process then ends at endblock 5418. If at decision block 5412 it is determined that the regimenshould not be, or cannot be, performed on site, the POC serviceprovider, through the healthcare provider administering the POCservices, through the application, or otherwise, interfaces with apharmacy or healthcare provider to provide the therapeutic regimen tothe user. The process then ends at end block 5418.

Referring now to FIG. 55 , there is illustrated a flowchart of oneembodiment of a POC services provisioning process 5500. The process 5500begins at step 5502 when the central server 5102 receives a request forPOC services, such as the requests provided by the application on themobile device 5104 as described herein. At decision block 5504 themobile POC unit determines whether to accept the request. The mobile POCunit may be given the freedom to accept the request or deny the request,allowing another mobile POC unit to accept the request. The mobile POCunit may deny the request it if is too far away, if the mobile POC unitwill soon be logging off, or for other reasons. In some embodiments, therequest is specific to a mobile POC unit and the mobile POC unit has atime window to accept or deny the request. In some embodiments, therequest may be transmitted by the central server to all available mobileunits in geographic proximity to the patient mobile device 5104,allowing any one of the available mobile units to accept the request. Ifthe request is not accepted by a mobile unit, the process loops back tostep 5502 where the mobile unit receives a new request. If the requestis accepted at decision block 5504, the process 5500 flows to step 5506.

At step 5506, the mobile POC unit travels to the location of the userand/or the patient mobile device 5104. At step 5508, the mobile POC unittransmits the location of the mobile POC unit to the user and/or thepatient mobile device 5104. The location of the mobile unit may beviewable by the user on the patient mobile device 5104 as the mobileunit travels to the user, so that the user can see the current locationof the mobile unit and how long it will take for the mobile unit toarrive. At decision block 5510, it is determined in the mobile unit hasarrived that the location of the user or the patient mobile device 5104.If not, the process loops back to step 5506. If so, the process flows tostep 5512, where a notification of arrival status is transmitted to thepatient mobile device 5104, either from the mobile unit 5108, or fromthe central server 5102.

At step 5514, POC tests are conducted by a medical technician or otherhealthcare provider that arrived in the mobile unit at the location ofthe user or the patient mobile unit 5104, such conducting a diagnostictest on the user, a family member of the user, a pet, etc., such as themicrofluidic tests described herein, such as the RT lamp testing device.At decision block 5516, it is determined if a result is provided by thetests. If not, the process 5500 loops back to step 5514. If so, theprocess flows to step 5518 where the test results are transmitted to thecentral system or server 5102. At step 5520, a diagnosis is receivedfrom the central system. The diagnosis could be received by the mobilePOC unit 5108 or by the patient mobile device 5104.

At decision block 5522, it is determined whether an interface with ahealthcare professional is needed. In some situations, the personadministering the tests on the patient may not be qualified to offermedical advice, write prescriptions, or perform other medicaltreatments. In such a situation, the patient may be interfaced with aqualified medical professional. In some embodiments, this may beperformed via a telemedicine session as described in this disclosure. Insome embodiments, the patient may be referred to a medical professionalfor an in-person meeting. If a professional interface is needed, theprocess flows to step 5524 where the patient interfaces with the medicalprofessional. As a result of the professional interface, or if it isdetermined at decision block 5522 that a professional interface is notneeded, the process flows to step 5526 to complete the prescription andor treatment/therapy, such as that described with respect to steps5408-5418 of process 5318. The process 5500 then ends at end block 5528.

Referring now to FIG. 56 , there is illustrated a sequence diagram ofone embodiment of a mobile POC unit request and POC service process5600. The process 5600 begins at step 5604 where available mobile POCunits are viewed in the application of the patient mobile device 5104.At step 5606, a request for a mobile POC unit is sent from the patientmobile device 5104 to the central server 5102. At step 5608, the centralserver 5102 transmits the POC service request to available mobile POCunits 5108. At step 5610, a mobile POC unit 5108 accepts the request andthe acceptance is transmitted to the central server 5102. At step 5612,the central server 5102 forwards the request acceptance to the patientmobile device 5104. At step 5614, the mobile POC unit 5108 transmits itscurrent location to the central server 5102, and at step 5616 thecentral server 5102 forwards the current location to the patient mobiledevice 5108 so that the patient mobile device 5108 can display thecurrent location of the mobile POC unit to the user.

At step 5618, the mobile POC unit 5108 transmits an arrival status tothe central server 5102, and, at step 5620, the central server 5102forwards the arrival status to the patient mobile device 5104. At step5622, upon arrival to the location of the user and the patient mobiledevice 5104, the mobile POC unit performs POC tests, such as medicaldiagnostic tests such as those described herein using microfluidicmedical testing devices. At step 5624, test results are transmitted fromthe mobile POC unit 5108 to the central server 5102. At step 5626, thecentral server 5102 determines a diagnosis and generates a treatmentplan based on the received test results. At step 5628, the centralserver 5102 transmits the diagnosis and treatment plan to the mobile POCunit 5108. In some embodiments, the diagnosis and treatment plan may besent to the patient mobile device 5104 also. At step 5630, the mobilePOC unit 5108 confirms the treatment plan with the patient. In someembodiments, if a staff of the mobile POC unit 5108 is not qualified orotherwise unable to provide medical advice, prescriptions, or medicaltreatment or therapy to the user, at step 5630 a telemedicine conferencemay be initiated, either by the patient mobile device 5104 or a deviceof the mobile POC unit 5108, to connect the user with a qualifiedmedical professional to go over the diagnosis and the treatment planwith the patient.

At step 5632, the mobile POC unit 5108 sends a confirmation of thetreatment plan and any prescriptions or other treatments with thecentral server 5102. In some embodiments, the patient mobile device 5104or a telemedicine professional may provide the confirmation of thetreatment plan to the central server 5102. At step 5634, the centralserver updates the patient profile for use in the analytical systemsdisclosed herein. At step 5636, the central server 5102 requestsprescription(s) from a pharmacy 5602. At step 5638, the pharmacy 5602transmits a confirmation of delivery of the prescription(s) to thepatient to the central server 5102. At step 5640, the central server5102 forwards the deliver confirmation to the patient mobile device5104.

It should be understood that the drawings and detailed descriptionherein are to be regarded in an illustrative rather than a restrictivemanner, and are not intended to be limiting to the particular forms andexamples disclosed. On the contrary, included are any furthermodifications, changes, rearrangements, substitutions, alternatives,design choices, and embodiments apparent to those of ordinary skill inthe art, without departing from the spirit and scope hereof, as definedby the following claims. Thus, it is intended that the following claimsbe interpreted to embrace all such further modifications, changes,rearrangements, substitutions, alternatives, design choices, andembodiments.

What is claimed is:
 1. A method for a microfluidic testing device, themethod comprising: receiving, by a server from a mobile device, arequest for point-of-care (POC) services at a location of the mobiledevice; receiving a biologic sample, the biologic sample containing apredetermined biologic material for treatment by one of a plurality oftreatment agents, holding the biologic sample containing thepredetermined biologic material within a first reservoir, pumping aportion of the biologic sample into each of a first plurality ofparallel pathways from the first reservoir using a micro-pump, applyinga separate treatment agent of the plurality of treatment agents withineach of the first plurality of parallel pathways to the portion of thebiologic sample within the parallel pathway, determining a treatmentagent of the plurality of treatment agents providing a treatmentefficacy for the predetermined biologic material within the biologicsample, pumping a second portion of the biologic sample into a selectedsecond parallel pathway associated with the determined treatment agentof a second plurality of parallel pathways from the first reservoirusing a second micro-pump, applying the determined treatment agent at aplurality of different dosage levels within the selected second parallelpathway to the second portion of the biologic sample within the selectedsecond parallel pathway, and determining a dosage level of the pluralityof different dosage levels of the determined treatment agent providingthe treatment efficacy; and receiving, at the server, a confirmation ofdelivery of the POC services.
 2. The method of claim 1, furthercomprising: providing an output indicating the determined treatmentagent and the dosage level of the determined treatment agent providingthe treatment efficacy; and receiving, at the server, one or more testresults as a result of operation of the microfluidic testing device,wherein the one or more test results includes a determination of thetreatment efficacy and the dosage level of the determined treatmentagent.
 3. The method of claim 2, further comprising: generating, at theserver, an updated digital patient record reflecting the one or moretest results; and transmitting, by the server to a medical entity, atreatment plan based on the treatment efficacy and the dosage leveldetermined for the determined treatment agent, wherein the treatmentplan is a dosage regimen for the determined treatment agent.
 4. Themethod of claim 3, further comprising storing, by the server, theupdated digital patient record in association with a database.
 5. Themethod of claim 3, further comprising receiving, by the server from themedical entity, a confirmation of the treatment plan.
 6. The method ofclaim 5, wherein the confirmation of the treatment plan includesprescription information.
 7. The method of claim 6, further comprising:transmitting, by the server, a prescription request corresponding to theprescription information to a pharmacy; and receiving, by the serverfrom the pharmacy, a confirmation of delivery of a prescription to apatient.
 8. The method of claim 2, further comprising: receiving, by theserver from a research database, a request for data on one or moremedical conditions; and transmitting, by the server, informationconcerning the one or more medical conditions for storage on theresearch database.
 9. The method of claim 1, further comprising: holdingthe portion of the biologic sample treated with one of the plurality oftreatment agents in a plurality of second reservoirs; and detecting thetreatment efficacy of the plurality of treatment agents on thepredetermined biologic material within the biologic sample through aplurality of second viewing windows each associated with one of theplurality of second reservoirs.
 10. The method of claim 9, wherein thestep of pumping the portion of the biologic sample further comprisespumping the portion of the biologic sample through a plurality ofmicro-channels into the plurality of second reservoirs.
 11. A systemcomprising: a server configured to: receive, from a mobile device, arequest for point-of-care (POC) services at a location of the mobiledevice; and receive a confirmation of delivery of the POC services, amicrofluidic testing device, wherein the microfluidic testing device isconfigured to: receive a biologic sample, the biologic sample containinga predetermined biologic material for treatment by one of a plurality oftreatment agents, hold the biologic sample containing the predeterminedbiologic material within a first reservoir, pump a portion of thebiologic sample into each of a first plurality of parallel pathways fromthe first reservoir using a micro-pump, apply a separate treatment agentof the plurality of treatment agents within each of the first pluralityof parallel pathways to the portion of the biologic sample within theparallel pathway, determine a treatment agent of the plurality oftreatment agents providing a treatment efficacy for the predeterminedbiologic material within the biologic sample responsive to the pluralityof treatment agents applied to the portion of the biologic sample withineach of the first plurality of parallel pathways, pump a second portionof the biologic sample into a selected second parallel pathwayassociated with the determined treatment agent of a second plurality ofparallel pathways from the first reservoir using a second micro-pump,apply the determined treatment agent at a plurality of different dosagelevels within the selected second parallel pathway to the second portionof the biologic sample within the selected second parallel pathway,determine a dosage level of the plurality of different dosage levels ofthe determined treatment agent with respect to the predeterminedbiologic material providing the treatment efficacy.
 12. The system ofclaim 11, wherein the microfluidic testing device is further configuredto provide an output indicating the determined treatment agent and thedosage level of the determined treatment agent providing the treatmentefficacy, and the server further comprising: a network interface; atleast one memory; and at least one processor coupled to the at least onememory and the network interface, wherein the at least one processor isconfigured to receive, via the network interface, one or more testresults as a result of operation of the microfluidic testing device,wherein the one or more test results includes a determination of thetreatment efficacy and the dosage level of the determined treatmentagent.
 13. The system of claim 12, wherein the at least one processor isfurther configured to: generate an updated digital patient recordreflecting the one or more test results; and transmit, to a medicalentity via the network interface, a treatment plan based on thetreatment efficacy and the dosage level determined for the determinedtreatment agent, wherein the treatment plan is a dosage regimen for thedetermined treatment agent.
 14. The system of claim 13, wherein the atleast one processor is further configured to store the updated digitalpatient record in association with a database.
 15. The system of claim13, wherein the at least one processor is further configured to receive,from the medical entity via the network interface, a confirmation of thetreatment plan.
 16. The system of claim 15, wherein the confirmation ofthe treatment plan includes prescription information.
 17. The system ofclaim 16, wherein the at least one processor is further configured to:transmit, via the network interface, a prescription requestcorresponding to the prescription information to a pharmacy; andreceive, via the network interface, a confirmation of delivery of aprescription to a patient.
 18. The system of claim 12, wherein the atleast one processor is further configured to: receive, from a researchdatabase via the network interface, a request for data on one or moremedical conditions; and transmit, via the network interface, informationconcerning the one or more medical conditions for storage on theresearch database.
 19. The system of claim 11, wherein, to determine thedetermined treatment agent of the plurality of treatment agentsproviding the treatment efficacy, the microfluidic testing device isfurther configured to: hold the portion of the biologic sample treatedwith one of the plurality of treatment agents in a plurality of secondreservoirs; and detect the treatment efficacy of the plurality oftreatment agents on the predetermined biologic material within thebiologic sample through a plurality of second viewing windows eachassociated with one of the plurality of second reservoirs.
 20. Thesystem of claim 19, wherein, to pump the portion of the biologic sample,the microfluidic testing device is further configured to pump theportion of the biologic sample through a plurality of micro-channelsinto the plurality of second reservoirs.